title: Reduction in mortality in severe acute pancreatitis: A time trend analysis over 16 years.
abstract: BACKGROUND
  The trend in the outcome of patients with acute pancreatitis (AP) as a result of evolving management practices is not known.
  
  
  OBJECTIVE
  To study and compare the outcomes of patients with AP at a tertiary care academic center over a period of 16 years.
  
  
  METHODS
  In a retrospective study on a prospectively acquired database of patients with AP, we analyzed time trends of severity and mortality of AP. The influence of determinants of severity [APACHE II score, organ failure (OF), infected pancreatic necrosis (IPN)], and management strategy on the actual and predicted mortality was assessed. The actual mortality was adjusted for severity to analyze the severity-adjusted mortality at different times as a reflection of management practices over time.
  
  
  RESULTS
  A total of 1333 patients were studied. The number of patients hospitalized with AP has been increasing over time. The proportion of patients with severe AP also increased from 1997 to 2013 as shown by increasing incidence of organ failure and IPN (Spearman's rank correlation coefficient (ρ): OF ρ(17) = 0.797, p < 0.01; IPN ρ(17) = 0.739, p < 0.001), indicating an increasing referral of sicker patients. Consequently, the overall mortality has been increasing (ρ(17) = 0.584; p = 0.014). However, despite increasing severity of AP, the mortality adjusted for OF has decreased significantly (ρ(17) = -0.55, p = 0.02).
  
  
  CONCLUSIONS
  Even with increasing proportion of patients with severe AP, there has been a significant decrease in organ failure adjusted mortality due to AP suggesting improved management over years.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Samagra
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: John
authors.initials: J
authors.lastname: George
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Padhan
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Padmaprakash K
authors.initials: PK
authors.lastname: Vadiraja
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sanatan
authors.initials: S
authors.lastname: Behera
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Hasan
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajan
authors.initials: R
authors.lastname: Dhingra
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Shalimar
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: pkgarg@aiims.ac.in.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Garg
mesh_terms: D001424:Bacterial Infections; D006801:Humans; D009102:Multiple Organ Failure; D009336:Necrosis; D010195:Pancreatitis / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Acute pancreatitis; Infected pancreatic necrosis; Mortality; Organ failure; Prognosis; Time-trends