Impact of radiologic intervention on mortality in necrotizing pancreatitis: the role of organ failure.
BACKGROUND
Our group previously reported that organ failure and mortality in necrotizing pancreatitis (NP) are not different between patients with infected and sterile necrosis. Since that report, management of this disease has evolved to include image-guided percutaneous catheter drainage (PCD) to improve morbidity and mortality. We evaluated the effect of PCD on mortality in NP.


METHODS
Retrospective analysis.


METHODS
Tertiary care referral center.


METHODS
A total of 689 consecutive patients treated for acute pancreatitis between 2001 and 2005, of whom 64 (9.3%) had pancreatic necrosis documented on contrast-enhanced computed tomography.


METHODS
Mortality and organ failure.


RESULTS
In the 64 patients with documented NP, overall mortality was 16%. Thirty-six patients (56%) had organ failure according to the Atlanta classification. Compared with patients with sterile necrosis, those with infected necrosis did not have an increased prevalence of organ failure or increased need for intubation, pressors, or dialysis but had an increased mortality. Mortality in patients treated conservatively was 1 of 29 (3%); in those with PCD alone, 6 of 11 (55%); in those with PCD and surgery, 2 of 17 (12%); and in those with surgery alone, 1 of 7 (14%). All patients treated with PCD alone had organ failure, whereas 10 (59%) of those with PCD and surgery had organ failure.


CONCLUSIONS
The use of PCD did not improve the mortality of NP among patients with organ failure.
Rocha
Flavio G
FG
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Benoit
Eric
E
Zinner
Michael J
MJ
Whang
Edward E
EE
Banks
Peter A
PA
Ashley
Stanley W
SW
Mortele
Koenraad J
KJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult