title: Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the influence of infection on mortality in necrotizing pancreatitis.
  
  
  METHODS
  Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed with subgroup, sensitivity, and meta-regression analyses to evaluate sources of heterogeneity.
  
  
  RESULTS
  We included 71 studies (n = 6970 patients). Thirty-seven (52%) studies used a prospective design and 25 scored ≥5 points on the NOS suggesting a low risk of bias. Forty studies were descriptive and 31 studies evaluated invasive interventions. In total, 801 of 2842 patients (28%) with infected necroses and 537 of 4128 patients (13%) with sterile necroses died with an odds ratio [OR] of 2.57 (95% confidence interval [CI], 2.00-3.31) based on all studies and 2.02 (95%CI, 1.61-2.53) in the studies with the lowest bias risk. The OR for prospective studies was 2.96 (95%CI, 2.51-3.50). In sensitivity analyses excluding studies evaluating invasive interventions, the OR was 3.30 (95%CI, 2.81-3.88). Patients with infected necrosis and organ failure had a mortality of 35.2% while concomitant sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%.
  
  
  CONCLUSIONS
  Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure and infected necrosis increase mortality in necrotizing pancreatitis.
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Werge
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Srdan
authors.initials: S
authors.lastname: Novovic
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
authors.forename: Palle N
authors.initials: PN
authors.lastname: Schmidt
authors.affiliation: Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark. Electronic address: lise.lotte.gluud.01@regionh.dk.
authors.forename: Lise L
authors.initials: LL
authors.lastname: Gluud
mesh_terms: D006801:Humans; D007239:Infections / Q000150:complications* / Q000401:mortality*; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000401:mortality*; D016896:Treatment Outcome
keywords: Acute pancreatitis; Death; Infected necrosis; Meta-analysis; Organ failure