Determinants of ICU mortality in necrotizing pancreatitis: the influence of Staphylococcus epidermidis.
BACKGROUND
The severity of acute necrotizing pancreatitis ranges from self-limited to rapidly progressive illness leading to multiple organ failure. Several scoring systems and clinical parameters have been used to predict the course of the disease. The aim of this study was to evaluate the clinical and microbiological determinants of poor outcome in necrotizing acute pancreatitis.


METHODS
Medical records of 67 consecutive patients admitted to the intensive care unit (ICU) of Oulu University Hospital due to acute necrotizing pancreatitis were retrospectively analyzed. All patients received standard surgical intensive care.


RESULTS
Patients who died (n=14) had significantly higher APACHE II, SAPS II and Ranson scores at admission to the ICU and maximum SOFA score achieved during ICU stay than did the survivors. The non-survivors were hospitalized later from the time the symptoms were first manifest (5.3 vs. 2.4 days, P=0.051). Mechanical ventilation (P=0.002), surgical management (P=0.028), open packing surgical management (P=0.03), renal replacement therapy (P<0.001), use of inotropic drugs (P=0.012) and Staphylococcus epidermidis growth (P=0.029) in infected pancreatic tissue were all associated with mortality.


CONCLUSIONS
In this study the time to hospitalization, severity of illness, intensity of care, and surgical management were associated with poor outcome. In addition, Staphylococcus epidermidis in pancreatic necrosis was associated with increased mortality.
Ala-Kokko
T I
TI
Department of Anesthesiology, Division of Intensive Care, and Infection Control, University of Oulu, Oulu, Finland. tak@cc.oulu.fi
Tieranta
N
N
Laurila
J
J
Syrjälä
H
H
D018806:APACHE; D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000401:mortality*; D013212:Staphylococcus epidermidis; D017741:Survivors; D016896:Treatment Outcome