Early organ dysfunction affects long-term survival in acute pancreatitis patients

Abstract

BackgroundThe effect of early organ dysfunction on long-term survival in acute pancreatitis (AP) patients is unknown. ObjectiveThe aim of this study was to ascertain whether early organ dysfunction impacts on long-term survival after an episode of AP. MethodsA retrospective analysis was performed using survival data sourced from a prospectively maintained database of patients with AP admitted to the Royal Infirmary of Edinburgh during a 5-year period commencing January 2000. A multiple organ dysfunction syndrome (MODS) score of ≥2 during the first week of admission was used to define early organ dysfunction. After accounting for in-hospital deaths, long-term survival probabilities were estimated using the Kaplan–Meier test. The prognostic significance of patient characteristics was assessed by univariate and multivariate analyses using Cox's proportional hazards methods. ResultsA total of 694 patients were studied (median follow-up: 8.8 years). Patients with early organ dysfunction (MODS group) were found to have died prematurely [mean survival: 10.0 years, 95% confidence interval (CI) 9.4–10.6 years] in comparison with the non-MODS group (mean survival: 11.6 years, 95% CI 11.2–11.9 years) (log-rank test, P=0.001) after the exclusion of in-hospital deaths. Multivariate analysis confirmed MODS as an independent predictor of long-term survival [hazard ratio (HR): 1.528, 95% CI 1.72–2.176; P=0.019] along with age (HR: 1.062; P<0.001), alcohol-related aetiology (HR: 2.027; P=0.001) and idiopathic aetiology (HR: 1.548; P=0.048). ConclusionsEarly organ dysfunction in AP is an independent predictor of long-term survival even when in-hospital deaths are accounted for. Negative predictors also include age, and idiopathic and alcohol-related aetiologies.