Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis.
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.
Garg
Pramod Kumar
PK
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Madan
Kaushal
K
Pande
Girish Kumar
GK
Khanna
Sudeep
S
Sathyanarayan
Garipati
G
Bohidar
Narendra Prasad
NP
Tandon
Rakesh Kumar
RK
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