Impact of etiology on course and outcomes of severe acute pancreatitis

Giedrius Barauskas,Povilas Ignatavičius,Astra Vitkauskienė,Juozas Pundzius,Žilvinas Dambrauskas

doi:10.1016/j.medici.2015.04.002

Giedrius Barauskas, Povilas Ignatavičius + Show 3 more

Open Access

https://doi.org/10.1016/j.medici.2015.04.002

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Journal: Medicina	Publication Date: Jan 1, 2015
Citations: 8	License type: cc-by

Affiliation: Lithuanian University of Health Sciences

Abstract

Background and objectiveSince the influence of etiological factors on the course and outcomes of acute pancreatitis (AP) is not fully understood yet, the aim of the study was to compare the outcomes of alcoholic and biliary severe acute pancreatitis (SAP). Materials and methodsWe investigated 81 patients with alcoholic and biliary SAP. Demographic data, etiologic factors, severity scores, intra-abdominal pressure, imaging studies, interventions, and treatment outcomes were prospectively entered into specially maintained database and subsequently analyzed. ResultsNo statistically significant difference was observed in the prevalence of SAP in biliary and alcoholic AP groups (P=0.429). Although, in the biliary SAP group patients were predominantly elderly women (P=0.003), the total in-hospital stay was longer in alcoholic SAP patients (P=0.021). The abdominal compartment syndrome developed more frequently (P=0.041) and necrosectomy was more frequently performed in alcoholic SAP group (not statistically significant). Although not statistically significant, a lower mortality rate among biliary SAP patients (25.0% vs. 13.5%) was observed. ConclusionsWe defined a trend toward decreased incidence of infected necrosis in larger volume (≥30%) pancreatic necrosis, absence of abdominal compartment syndrome, lower rate of necrosectomies, shorter in-hospital stay, and an insignificantly reduced mortality rate in biliary SAP patients, indicating more favorable course of biliary SAP.

Highlights

Throughout the last decades, acute pancreatitis (AP) remains one of the most extensively investigated therapeutic problems with a hardly improvable course
We defined a trend toward decreased incidence of infected necrosis in larger volume (≥30%) pancreatic necrosis, absence of abdominal compartment syndrome, lower rate of necrosectomies, shorter in-hospital stay, and an insignificantly reduced mortality rate in biliary severe acute pancreatitis (SAP) patients, indicating more favorable course of biliary SAP
About 25% of the patients with AP develop severe acute pancreatitis (SAP), which is strongly associated with organ failure and local complications such as pancreatic or peripancreatic necrosis, formation of walled-off necrosis or pseudocyst; infected pancreatic necrosis is observed in 30%–70% of SAP patients [3]

Summary

Introduction

Throughout the last decades, acute pancreatitis (AP) remains one of the most extensively investigated therapeutic problems with a hardly improvable course. Results: No statistically significant difference was observed in the prevalence of SAP in biliary and alcoholic AP groups (P = 0.429). In the biliary SAP group patients were predominantly elderly women (P = 0.003), the total in-hospital stay was longer in alcoholic SAP patients (P = 0.021). The abdominal compartment syndrome developed more frequently (P = 0.041) and necrosectomy was more frequently performed in alcoholic SAP group (not statistically significant). A lower mortality rate among biliary SAP patients (25.0% vs 13.5%) was observed. Conclusions: We defined a trend toward decreased incidence of infected necrosis in larger volume (≥30%) pancreatic necrosis, absence of abdominal compartment syndrome, lower rate of necrosectomies, shorter in-hospital stay, and an insignificantly reduced mortality rate in biliary SAP patients, indicating more favorable course of biliary SAP

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