Related Experiment Video
Updated: Jul 5, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection
Marie Dejonckheere1, Massimo Antonelli2,3, Kostoula Arvaniti4
1Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Insights
Pancreatic infection in ICU patients has high mortality. Persistent inflammation and localized peritonitis are key risk factors, not the AbSeS classification components. Further research is needed for better outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Surgical Infections
Background:
- The AbSeS classification system categorizes intra-abdominal infections based on onset, peritonitis, and severity.
- This system has shown reliable risk stratification in intensive care unit (ICU) patients.
- Pancreatic infection presents unique challenges within the broader category of intra-abdominal infections.
Purpose of the Study:
- To investigate the epidemiology of pancreatic infections in ICU patients.
- To evaluate the association between AbSeS classification components and mortality in this specific patient group.
- To identify independent risk factors for mortality in ICU patients with pancreatic infections.
Main Methods:
- Secondary analysis of the international observational AbSeS study.
- Inclusion of 165 ICU patients diagnosed with pancreatic infection.
- Logistic regression analysis to assess mortality risk factors, reporting odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Overall ICU mortality was 35.2%.
- Independent risk factors for mortality included older age (OR=1.03), localized peritonitis (OR=4.4), and persistent inflammation at day 7 (OR=9.5) or after early interventions (OR=4.0).
- Gram-negative bacteria were the most common pathogens (49.2%), with no significant differences between survivors and non-survivors.
Conclusions:
- Challenging source control and ongoing pancreatic inflammation are major contributors to poor short-term outcomes in pancreatic infections.
- The study suggests that components of the AbSeS classification (onset, diffuse peritonitis, severity) were not significantly associated with increased mortality in this cohort.
- Further investigation is warranted to refine risk stratification and management strategies for ICU patients with pancreatic infections.
Background:
The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.
Methods:
This was a secondary analysis of an international observational study ("AbSeS") investigating ICU patients with intra-abdominal infection. Only patients with pancreatic infection were included in this analysis (n=165). Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU. Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio (OR) and 95% confidence interval (CI).
Results:
The overall mortality was 35.2% (n=58). The independent risk factors for mortality included older age (OR=1.03, 95% CI: 1.0 to 1.1 P=0.023), localized peritonitis (OR=4.4, 95% CI: 1.4 to 13.9 P=0.011), and persistent signs of inflammation at day 7 (OR=9.5, 95% CI: 3.8 to 23.9, P<0.001) or after the implementation of additional source control interventions within the first week (OR=4.0, 95% CI: 1.3 to 12.2, P=0.013). Gram-negative bacteria were most frequently isolated (n=58, 49.2%) without clinically relevant differences in microbial etiology between survivors and non-survivors.
Conclusions:
In pancreatic infection, a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome. In this limited series, essentials of the AbSeS-classification, such as the setting of infection onset, diffuse peritonitis, and severity of disease expression, were not associated with an increased mortality risk.ClinicalTrials.gov number: NCT03270345.
More Related Videos
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
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:
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...