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Abstract

Severe Acute Pancreatitis - Time for a New Stratification

Context Acute pancreatitis is a common surgical emergency. Severe acute pancreatitis has high mortality despite best efforts, and often requires intensive care. Objectives We aimed to evaluate the management and outcome of patients admitted with severe acute pancreatitis to our intensive treatment unit and identify their determinants of survival. Methods All patients admitted with severe acute pancreatitis to our intensive treatment unit between 2007 and 2010 were retrospectively reviewed. Outcome, clinico-pathological, demographic and radiological information were recorded. Results 75 patients were admitted, with an overall mortality of 32%. 51 had complete data for analysis. The median age was 64 years (range 23-95); survivors were younger (median age - 49 years) (p<0.001). There was no significant difference between survivors and non-survivors in relation to C-reactive protein (p=0.898) or lactate dehydrogenase (p=0.291). Antimicrobials did not improve survival (p=0.70), although indications and prescription regimes were heterogeneous. Significant determinants of mortality were presence of persistent organ failure or infected pancreatic necrosis (P=0.002 & P=0.003 respectively). These were used to divide patients into Groups: I – no organ failure or pancreatic necrosis; II – transient organ failure or sterile necrosis; III – persistent Organ Failure or infected pancreatic necrosis; IV – early persistent organ failure ± infected pancreatic necrosis and V – persistent organ failure and infected pancreatic necrosis. All patients who died were in groups III-V, with increasing mortality in higher groups. Conclusions Our mortality rate was comparable to the national standard, with higher fatality in older patients. Antimicrobials did not impact on survival, but this requires further evaluation. There appears to be a need to subdivide patients with severe acute pancreatitis to better reflect their outcomes. Our data shows that patients in Groups I-II are likely to do better than group III. Earlier onset of persistent organ failure (Group IV) carries poorer prognosis and combined persistent Organ Failure and infected pancreatic necrosis (Group V) carries the highest mortality. This classification appears to be a better predictor of mortality than Glasgow scoring.


Author(s):

Gaural Patel, Sugapriya Arunachalam, Paul Jarvis, Rhian Booth, Ganiy Opeyemi Abdulrahman Jnr, Omer Jalil, Ashraf Rasheed



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