IDDF2021-ABS-0134 Organ failure and infected pancreatic necrosis as determinants of mortality in patients with acute pancreatitis: an updated systematic review and meta-analysis

Abstract

<h3>Background</h3> In patients with acute pancreatitis, different minimally invasive approaches, and step-up approaches have been introduced and widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate the evidence from published studies during the last decade to determine the relative importance of IPN and OF as determinants of mortality in patients with AP. <h3>Methods</h3> The search for relevant studies was conducted in MEDLINE and EMBASE. The estimates are presented as relative risk (RR) or mean differences (MD) based on the type of outcomes. A two-sided P value less than 0.05 was regarded as statistical significance. <h3>Results</h3> Fourteen-three studies comprising 11,601 patients with acute pancreatitis were meta-analyzed. Among them, 28% with OF (814 of 2,901 patients) and 24% with IPN (504 of 2,108 patients) died. Patients with OF and no IPN had a significantly higher risk of death in comparison with patients with IPN and no OF (RR = 3.72; 95% CI: 2.02-6.84; P &lt; 0.0001), though patients with OF and IPN still had a significantly higher risk of death as compared with patients with OF and no IPN (RR=1.50; 95% CI: 1.16-1.95; P=0.002) and patients with IPN and no OF (RR = 4.58; 95% CI: 3.15-6.68; P &lt; 0.0001). In addition, IPN prolonged the length of stay in hospital for patients with OF (MD = 28.75; 95% CI: 2.53-54.97; P = 0.032). <h3>Conclusions</h3> With the advances in the management of IPN, IPN becomes a less important determinant of mortality as compared with OF. However, IPN is still responsible for increased morbidity and prolonged hospital stay.