TY - JOUR
T1 - Natural History After Acute Necrotizing Pancreatitis
T2 - a Large US Tertiary Care Experience
AU - Umapathy, Chandraprakash
AU - Raina, Amit
AU - Saligram, Shreyas
AU - Tang, Gong
AU - Papachristou, Georgios I.
AU - Rabinovitz, Mordechai
AU - Chennat, Jennifer
AU - Zeh, Herbert
AU - Zureikat, Amer H.
AU - Hogg, Melissa E.
AU - Lee, Kenneth K.
AU - Saul, Melissa I.
AU - Whitcomb, David C.
AU - Slivka, Adam
AU - Yadav, Dhiraj
N1 - Publisher Copyright:
© 2016, The Society for Surgery of the Alimentary Tract.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. Methods: Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted. Results: Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p < 0.001). Increasing age (HR 1.05), persistent organ failure (HR 4.5), and >50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively. Conclusion: ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
AB - Background: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. Methods: Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted. Results: Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p < 0.001). Increasing age (HR 1.05), persistent organ failure (HR 4.5), and >50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively. Conclusion: ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
KW - Disability
KW - Endocrine insufficiency
KW - Mortality
KW - Necrotizing
KW - Pancreatic enzyme replacement therapy
KW - Pancreatitis
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84987621337&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84987621337&partnerID=8YFLogxK
U2 - 10.1007/s11605-016-3264-2
DO - 10.1007/s11605-016-3264-2
M3 - Article
C2 - 27619808
AN - SCOPUS:84987621337
SN - 1091-255X
VL - 20
SP - 1844
EP - 1853
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 11
ER -