Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis?
BACKGROUND
We previously reported that organ failure occurs in 50% of patients with necrotizing pancreatitis, that extended pancreatic necrosis (greater than 50% necrosis) is not associated with an increased prevalence of organ failure or infected necrosis, and that the prevalence of organ failure is similar in sterile necrosis and infected necrosis. AIMS To analyze these relations in a larger group of patients and to evaluate other factors that might have prognostic significance.


METHODS
We reviewed 1,110 consecutive cases of acute pancreatitis between January 1, 1995, and January 1, 2000. Necrosis was documented by contrast-enhanced CT. A value less than 0.05 was considered significant.


RESULTS
Ninety-nine patients (9%) had necrotizing pancreatitis; 52% had organ failure. Patients with extended pancreatic necrosis did not have increased prevalence of organ failure or infected necrosis but did have an increased need for intubation and an increased mortality rate associated with multiple organ failure. Patients with infected necrosis did not have an increased prevalence of organ failure but did have a marginally increased prevalence of multiple organ failure and increased need for intubation. Overall mortality was 14% and was markedly increased among patients with organ failure at admission (47%) and among patients who had multiple organ failure during the hospitalization (49%).


CONCLUSIONS
Although severity of necrotizing pancreatitis was somewhat increased in extended pancreatic necrosis and infected necrosis, mortality was more strongly linked to organ failure at admission and multiple organ failure during hospitalization.
Perez
Alexander
A
Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Whang
Edward E
EE
Brooks
David C
DC
Moore
Francis D
FD
Hughes
Michael D
MD
Sica
Gregory T
GT
Zinner
Michael J
MJ
Ashley
Stanley W
SW
Banks
Peter A
PA
D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D014057:Tomography, X-Ray Computed