Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience.
Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP.



Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted.



Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p < 0.001). Increasing age (HR 1.05), persistent organ failure (HR 4.5), and >50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively.



ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Chandraprakash
C
Umapathy
Division of Gastroenterology, Hepatology, and Nutrition, East Carolina University, Greenville, NC, USA.
Amit
A
Raina
Division of Gastroenterology, Hepatology, and Motility, University of Kansas Medical Center, Kansas City, KS, USA.
Shreyas
S
Saligram
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
Gong
G
Tang
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA.
Georgios I
GI
Papachristou
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA.
Mordechai
M
Rabinovitz
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA.
Jennifer
J
Chennat
Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Herbert
H
Zeh
Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Amer H
AH
Zureikat
Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Melissa E
ME
Hogg
Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Kenneth K
KK
Lee
Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA.
Melissa I
MI
Saul
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA.
David C
DC
Whitcomb
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA.
Adam
A
Slivka
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA. yadavd@upmc.edu.
Dhiraj
D
Yadav
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D063128:Tertiary Health Care / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
Disability; Endocrine insufficiency; Mortality; Necrotizing; Pancreatic enzyme replacement therapy; Pancreatitis; Survival