title: Severe pancreatitis. Determinants of mortality in a tertiary referral center.
abstract: OBJECTIVE
  To determine factors associated with mortality in patients with severe pancreatitis.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University tertiary referral center intensive care unit (ICU).
  
  
  METHODS
  Thirty patients admitted to the ICU with the primary diagnosis of pancreatitis from 1986 to 1995.
  
  
  METHODS
  Survival vs nonsurvival.
  
  
  RESULTS
  Twenty-seven patients were transferred from another institution. At the time of ICU admission, subsequent death was not associated with the following: systolic blood pressure, pulse rate, hemoglobin level, leukocyte count, platelet count, or serum calcium concentration. The patients who died during the study were older at admission (age [mean+/-SD] of those who lived, 47+/-17 years; age of those who died, 64+/-8 years; P=.01) and their serum creatinine concentrations were higher (creatinine concentrations [mean +/-SD] of those who lived, 150+/-90 micromol/L [1.7+/-1.0 mg/dL]; creatinine concentrations of those who died, 410+/-250 micromol/L [4.6+/-2.8 mg/dL]; P=.001). Clinical events not associated with mortality included respiratory failure, insulin use, positive blood cultures, positive pancreatic cultures, and abdominal surgery for pancreatitis and infected pancreatic necrosis. Death was associated with the use of inotropic and/or vasopressor support (P=.05) and renal failure (creatinine, >170 micromol/L[>2.0 mg/dL]) at any time during the ICU stay (P=.01). Patients with renal failure were no older than the patients without, but were admitted later after the onset of pancreatitis (mean+/-SD, 5.9+/-7.2 days vs 1.5+/-1.1 days; P=.03; median, 2 days vs 1 days).
  
  
  CONCLUSIONS
  After hospital transfer to a teritiary referral center, only older age, use of inotropic and/or vasopressor support, and evidence of renal malfunction are associated with death. Prompt recognition of severe pancreatitis, especially in older patients, aggressive hemodynamic management, and/or earlier transfer to a tertiary care center may diminish the incidence of renal failure and mortality in severe pancreatitis.
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Malcynski
authors.forename: I C
authors.initials: IC
authors.lastname: Iwanow
authors.forename: K W
authors.initials: KW
authors.lastname: Burchard
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000401:mortality*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis