title: Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis.
abstract: OBJECTIVE
  There is no consistency between the individual studies in the literature on whether organ failure (OF) or infected pancreatic necrosis (IPN) is the main determinant of severity in acute pancreatitis. We aimed to statistically aggregate the available data and determine the pooled influence of OF and IPN on mortality in patients with acute pancreatitis.
  
  
  METHODS
  The search for relevant observational studies was undertaken in the MEDLINE, EMBASE, and Scopus electronic databases, as well as in the proceedings of major gastroenterology meetings. The summary estimates are presented as relative risk (RR) and 95% confidence interval (CI).
  
  
  RESULTS
  Fourteen studies comprising 1478 patients with acute pancreatitis were meta-analyzed. A total of 600 patients developed OF and 179 of them died (mortality, 30%); 314 patients developed IPN and 102 of them died (mortality, 32%). In a stratified analysis, patients with OF and IPN had a significantly higher risk of death in comparison with patients with OF and no IPN (RR = 1.94; 95% CI: 1.32-2.85; P = .0007) and in comparison with patients with IPN and no OF (RR = 2.65; 95% CI: 1.30-5.40; P = .0007).
  
  
  CONCLUSIONS
  In patients with acute pancreatitis, the absolute influence of OF and IPN on mortality is comparable and thus the presence of either indicates severe disease. The relative risk of mortality doubles when OF and IPN are both present and indicates extremely severe disease or critical acute pancreatitis.
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand. max.petrov@gmail.com
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Petrov
authors.forename: Satyanarayan
authors.initials: S
authors.lastname: Shanbhag
authors.forename: Mandira
authors.initials: M
authors.lastname: Chakraborty
authors.forename: Anthony R J
authors.initials: AR
authors.lastname: Phillips
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D001424:Bacterial Infections / Q000209:etiology / Q000401:mortality*; D016638:Critical Illness; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index