Targeted Adverse Outcomes in Acute Pancreatitis are Infrequent in Non-transferred Patients: Implications for Future Research Studies

Abstract

Purpose: Historically, outcomes of severity in acute pancreatitis have included the presence of necrosis, development of organ failure and the systemic inflammatory response syndrome (SIRS), need for intensive care unit (ICU) admission, length of hospitalization and death. We aimed to determine the frequency of these outcomes in a large retrospective database and evaluate the influence of transfer status as a possible confounder. Methods: All paper and electronic patient charts in those admitted to our medical center from 1985-2009 with a primary diagnosis of acute pancreatitis were retrospectively evaluated. Data in regards to demographics, process measures, and outcomes was abstracted. SIRS was defined as per standard criteria and organ failure per the revised Atlanta Classification classification. Means and standard deviations were used to characterize the population and direct admission and transfer groups were compared using the Fisher's exact and student's t-tests. Results: 489 patients presented directly to our center and 213 were admitted in transfer. The percent rate of SIRS and organ failure at admission, 24 hours, 48 hours and 72 hours are demonstrated in the Table for transferred and non-transferred patients. Transferred patients were also more likely than non-transferred patients to require ICU care (27.5% vs. 7.5%, p<0.001), develop necrosis (19.0% vs. 2.1%, p<0.001), require parenteral nutrition (69.1% vs. 29.7%, p<0.001), have intra-abdominal bacterial infections (11.0% vs. 2.7%, p<0.001) and die (9.3% vs. 3.5%, p<0.003). In non-transfer patients who died, 60% had SIRS and 29% had organ failure at admission, while the percent dropped to 29% for organ failure and SIRS at 72 hours. Conclusion: In patients not admitted in transfer, historical outcomes of severity in acute pancreatitis are infrequent. These results demonstrate the importance of stratification by transfer status when performing studies evaluating outcomes in acute pancreatitis.Table: Percent rates of SIRS and organ failure in study population