title: Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis.
abstract: BACKGROUND
  The incidence of respiratory failure and other respiratory complications in the early phase of acute pancreatitis (AP) is not well investigated.
  
  
  OBJECTIVE
  To evaluate the incidence and risk factors of respiratory failure, and its impact on mortality in the early phase AP.
  
  
  METHODS
  Retrospective cohort study including 359 patients admitted with acute pancreatitis. Information was gathered from electronic patient records. We defined respiratory failure based on the modified Marshall scoring system in the revised Atlanta criteria. Predictors of respiratory failure were evaluated in univariable and multivariable logistic regression analysis.
  
  
  RESULTS
  The cohort included 188 women and 171 men with a mean age of 56.1 years. Respiratory complications including pleural effusion, pneumonia and atelectasis were registered in 80 patients (22%), 100 (29%) needed oxygen therapy, 27 (8%) continuous positive airway pressure, and six (2%) mechanical ventilation. Thirty-two patients (9%) were treated with bronchodilators and 12 (3%) with steroids. Thirty-one patients (9%) fulfilled the diagnostic criteria for respiratory failure. Five of these patients (16%) did not have effusion, atelectasis or pneumonia. Predictors of respiratory failure in multivariable analysis were age (OR 1.04; CI 95% (1.03-1.07)) and smoking (OR 2.67; CI 95% (1.21-5.86)). Thirteen patients died in hospital. The Kaplan-Meier curves and log-rank tests showed that patients with respiratory failure had increased in-hospital mortality as did patients with cardiovascular and renal failure (P < 0.01 for all analyses).
  
  
  CONCLUSIONS
  Respiratory complications are frequent in the early phase of AP. Respiratory, cardiovascular and renal failure is associated with a poor outcome. The fact that patients without effusion, atelectasis, or pneumonia may develop respiratory failure, suggests that acute lung injury, possibly associated with systemic inflammation, may be important.
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Tilde
authors.initials: T
authors.lastname: Dombernowsky
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Marlene Østermark
authors.initials: MØ
authors.lastname: Kristensen
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Sisse
authors.initials: S
authors.lastname: Rysgaard
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Lise Lotte
authors.initials: LL
authors.lastname: Gluud
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark. Electronic address: srdan.novovic@regionh.dk.
authors.forename: Srdan
authors.initials: S
authors.lastname: Novovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality*; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D055815:Young Adult
keywords: Acute pancreatitis; Mortality; Organ failure; Respiratory complications; Respiratory failure