Infected Pancreatic Necrosis due to Multidrug-Resistant Organisms and Persistent Organ failure Predict Mortality in Acute Pancreatitis
Related Experiment Video
Updated: Feb 4, 2026
Preparing a Mice Model of Severe Acute Pancreatitis via a Combination of Caerulein and Lipopolysaccharide Intraperitoneal Injection
Published on: May 10, 2024
Saransh Jain1, Soumya Jagannath Mahapatra1, Swatantra Gupta1
1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Background:
Organ failure determines outcome in acute pancreatitis (AP). It is controversial if infected pancreatic necrosis (IPN) is also an independent determinant of mortality. We hypothesized that the predictors of mortality in AP might have changed with advances in management and consequent decline in mortality over the past decades. Our objective was to study the predictors of mortality in patients with AP.
Methods:
Consecutive patients with a first episode of AP hospitalized from January 2015 to December 2016 were included in an observational study. Patients with IPN were treated with a conservative first approach followed by intervention. Necrosectomy, if required, was delayed beyond 4 weeks and done primarily employing minimally invasive techniques. The primary outcome measure was independent predictors of in-hospital mortality.
Results:
Of 209 patients with AP, 81 (39%) had persistent organ failure (OF) and 108 (52%) developed IPN. Overall, 46/209 (22%) patients died. Independent predictors of mortality were OF (odds ratio [OR]19; 95% CI: 6.1-58.8), and IPN due to infection with multidrug resistant (MDR) organisms (OR: 8.4; 95% CI:3.1-22.5). Infected pancreatic necrosis by itself was not found to be a significant predictor of mortality (OR 2; 95% CI: 0.4-9.5).
Conclusion:
Persistent OF and complicated IPN due to MDR infection were independent predictors of mortality in patients with AP. Renewed efforts to prevent MDR infection with antibiotic stewardship and strategies for early control of sepsis are urgently required.
Insights
Persistent organ failure and multidrug-resistant infections in infected pancreatic necrosis are key predictors of mortality in acute pancreatitis. Early sepsis control and antibiotic stewardship are crucial for improving patient outcomes.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute pancreatitis (AP) outcomes are primarily determined by organ failure.
- The role of infected pancreatic necrosis (IPN) as an independent mortality predictor in AP remains debated.
- Advances in management may have altered mortality predictors over time.
Purpose of the Study:
- To identify independent predictors of mortality in patients with acute pancreatitis.
- To investigate the evolving landscape of mortality determinants in AP.
Main Methods:
- An observational study included consecutive patients hospitalized with a first episode of AP between January 2015 and December 2016.
- Patients with IPN were managed conservatively initially, with delayed, minimally invasive interventions if necessary.
- In-hospital mortality was the primary outcome, with independent predictors identified using statistical analysis.
Main Results:
- Of 209 AP patients, 81% had persistent organ failure (OF) and 52% developed IPN. Overall mortality was 22%.
- Independent predictors of mortality were persistent OF (OR 19) and IPN caused by multidrug-resistant (MDR) organisms (OR 8.4).
- IPN alone was not a significant predictor of mortality (OR 2).
Conclusions:
- Persistent organ failure and MDR infection-related IPN are independent predictors of mortality in AP.
- Urgent implementation of antibiotic stewardship programs and early sepsis control strategies are necessary to mitigate mortality.
- These findings highlight the critical impact of MDR organisms in complicated AP cases.
More Related Videos
Related Concept Videos
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:31Accessory Organs
01:30Acute Pancreatitis II: Clinical Manifestations and Management
02:18Types of Genetic Transfer Between Organisms
01:09Levels of Organization
Molecules Are Composed of Atoms, and Biomolecules Are Assembled from Molecules:
The most basic levels include atoms, molecules, and biomolecules. Atoms, the smallest unit of ordinary matter, are composed of a nucleus and electrons. Molecules...
03:02Organic Compounds