title: Improved outcome of severe acute pancreatitis in the intensive care unit.
abstract: Background. Severe acute pancreatitis (SAP) is associated with serious morbidity and mortality. Our objective was to describe the case mix, management, and outcome of patients with SAP receiving modern critical care in the Intensive Care Unit (ICU). Methods. Retrospective analysis of patients with SAP admitted to the ICU in a single tertiary care centre in the UK between January 2005 and December 2010. Results. Fifty SAP patients were admitted to ICU (62% male, mean age 51.7 (SD 14.8)). The most common aetiologies were alcohol (40%) and gallstones (30%). On admission to ICU, the median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17, the pancreatitis outcome prediction score was 8, and the median Computed Tomography Severity Index (CTSI) was 4. Forty patients (80%) tolerated enteral nutrition, and 46% received antibiotics for non-SAP reasons. Acute kidney injury was significantly more common among hospital nonsurvivors compared to survivors (100% versus 42%, P = 0.0001). ICU mortality and hospital mortality were 16% and 20%, respectively, and median lengths of stay in ICU and hospital were 13.5 and 30 days, respectively. Among hospital survivors, 27.5% developed diabetes mellitus and 5% needed long-term renal replacement therapy. Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity.
authors: Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's College London, London SE1 7EH, UK.
authors: Polychronis
authors: P
authors: Pavlidis
authors: Siobhan
authors: S
authors: Crichton
authors: Joanna
authors: J
authors: Lemmich Smith
authors: David
authors: D
authors: Morrison
authors: Simon
authors: S
authors: Atkinson
authors: Duncan
authors: D
authors: Wyncoll
authors: Marlies
authors: M
authors: Ostermann
references: Pancreatology. 2002;2(6):565-73
references: 12435871
references: Clin Gastroenterol Hepatol. 2010 Mar;8(3):303-8; quiz e33
references: 19879963
references: Crit Care. 2007;11(2):R31
references: 17331245
references: J Crit Care. 2010 Jun;25(2):225-9
references: 19781906
references: Cochrane Database Syst Rev. 2010 Jan 20;(1):CD002837
references: 20091534
references: Crit Care. 2007;11 Suppl 1:S1
references: 18275590
references: Gut. 1998 Jun;42(6):886-91
references: 9691932
references: Surg Gynecol Obstet. 1974 Jul;139(1):69-81
references: 4834279
references: Br J Surg. 1990 Nov;77(11):1260-4
references: 2253005
references: Lancet. 1989 Jul 22;2(8656):201-5
references: 2568529
references: Gut. 2005 May;54 Suppl 3:iii1-9
references: 15831893
references: Crit Care Med. 2007 Jul;35(7):1703-8
references: 17522578
references: Radiology. 1990 Feb;174(2):331-6
references: 2296641
references: Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
references: 7509706
references: Clin Gastroenterol Hepatol. 2010 Dec;8(12):1089-1094.e2
references: 20417724
references: Am J Gastroenterol. 2008 Jan;103(1):104-10
references: 17925000
references: N Engl J Med. 2010 Apr 22;362(16):1491-502
references: 20410514
references: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD002941
references: 17054156
references: JPEN J Parenter Enteral Nutr. 2006 Mar-Apr;30(2):143-56
references: 16517959
references: Intensive Care Med. 1996 Jul;22(7):707-10
references: 8844239
references: Br J Surg. 2000 Mar;87(3):362-73
references: 10718957
references: Aliment Pharmacol Ther. 2008 Oct 1;28(7):931-41
references: 18647283