title: The role of organ failure and infection in necrotizing pancreatitis: a prospective study.
abstract: OBJECTIVE
  To clarify the roles of organ failure and infection in the outcome of necrotizing pancreatitis.
  
  
  BACKGROUND
  Results of previous cohort studies that focused on the roles of infection and organ failure in acute pancreatitis are controversial.
  
  
  METHODS
  In this study, we collected the medical records of 447 patients with necrotizing pancreatitis from January 2009 to June 2012. Data associated with organ failure and infection were analyzed.
  
  
  RESULTS
  The overall mortality rate was 13% (58/447). Intervention was performed in 223 of 447 patients. Among these 223 patients, 134 were confirmed to be with infected necrosis by a positive culture. The mortality rate was 15% (13/89) in the sterile necrosis group and 18% (24/134) in the infected necrosis group (P = 0.52). A multivariate analysis of death predictors indicated that bacteremia (odds ratio [OR] = 2.76, 95% confidence interval [CI], 1.23-5.46, P < 0.001), age (OR = 1.07, 95% CI, 1.03-1.11, P < 0.001), American Society of Anesthesiologists class (OR = 3.56, 95% CI, 1.65-7.18, P = 0.001), persistent organ failure in the first week (OR = 16.72, 95% CI, 7.04-32.56, P < 0.001), and pancreatic necrosis (OR = 1.73, 95% CI, 1.14-2.98, P = 0.008) were significant factors.
  
  
  CONCLUSIONS
  Among patients with necrotizing pancreatitis, the effects of organ failure on mortality are more critical than those of infection. Bacteremia, age, American Society of Anesthesiologists class, persistent organ failure in the first week, and pancreatic necrosis were identified as the predictors of mortality.
authors.affiliation: *Hepato-Bilio-Pancreatic Surgery †Department of Integrated Traditional Chinese and Western Medicine ‡Intensive Care Unit §Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Guo
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.forename: Qing
authors.initials: Q
authors.lastname: Xia
authors.forename: Xubao
authors.initials: X
authors.lastname: Liu
authors.forename: Bole
authors.initials: B
authors.lastname: Tian
authors.forename: Gang
authors.initials: G
authors.lastname: Mai
authors.forename: Zongwen
authors.initials: Z
authors.lastname: Huang
authors.forename: Guangyuan
authors.initials: G
authors.lastname: Chen
authors.forename: Wenfu
authors.initials: W
authors.lastname: Tang
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Jin
authors.forename: Weixia
authors.initials: W
authors.lastname: Chen
authors.forename: Huimin
authors.initials: H
authors.lastname: Lu
authors.forename: Nengwen
authors.initials: N
authors.lastname: Ke
authors.forename: Zhaoda
authors.initials: Z
authors.lastname: Zhang
authors.forename: Weiming
authors.initials: W
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002423:Cause of Death / Q000639:trends; D002681:China / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016017:Odds Ratio; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D055815:Young Adult