title: Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis.
abstract: OBJECTIVE
  Organ failure is the usual cause of death in acute necrotizing pancreatitis. Our objective was to study whether the extent and infection of pancreatic necrosis correlate with organ failure and mortality.
  
  
  METHODS
  All consecutive patients with acute pancreatitis were prospectively studied. They underwent a detailed clinical and investigative evaluation. Pancreatic necrosis, diagnosed on a computed tomography scan, was graded as <30%, 30%-50%, and >50% necrosis and characterized as either sterile or infected. Logistic regression analysis was done to find out the association of the extent and infection of pancreatic necrosis with organ failure and mortality.
  
  
  RESULTS
  Of 276 patients (mean age, 41.25 years; 172 men), 104 had pancreatic necrosis: 30 had <30% necrosis, 37 had 30%-50% necrosis, and 37 had >50% necrosis; 74 had sterile necrosis, and 30 had infected necrosis. Of them, 37 (35%) patients developed organ failure. Two significant factors were associated with the development of organ failure, the extent of necrosis (<30% necrosis vs 30%-50% necrosis: P = .03; odds ratio [OR], 5.82; 95% confidence interval [CI], 1.15-29.45; <30% necrosis vs >50% necrosis: P = .0004; OR, 18.86; 95% CI, 3.75-94.92) and infected pancreatic necrosis (P = .02; OR, 3.29; 95% CI, 1.17-9.24). The overall mortality was 22%. Infected pancreatic necrosis (P = .006; OR, 4.99; 95% CI, 1.56-16.02) and Acute Physiology, Age, and Chronic Healthy Evaluation II score (P = .004; OR, 1.28; 95% CI, 1.08-1.52) were 2 independent predictors of mortality.
  
  
  CONCLUSIONS
  Extent of necrosis and infected pancreatic necrosis were associated with the development of organ failure in patients with acute necrotizing pancreatitis. Infected pancreatic necrosis was the most significant predictor of mortality.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Garg
authors.forename: Kaushal
authors.initials: K
authors.lastname: Madan
authors.forename: Girish Kumar
authors.initials: GK
authors.lastname: Pande
authors.forename: Sudeep
authors.initials: S
authors.lastname: Khanna
authors.forename: Garipati
authors.initials: G
authors.lastname: Sathyanarayan
authors.forename: Narendra Prasad
authors.initials: NP
authors.lastname: Bohidar
authors.forename: Rakesh Kumar
authors.initials: RK
authors.lastname: Tandon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D001707:Biopsy, Needle; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology*; D010186:Pancreatic Function Tests; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed