title: Ileus is a predictor of local infection in patients with acute necrotizing pancreatitis.
abstract: Infected pancreatic necrosis (IPN) is associated with increased morbidity and mortality. Gut barrier dysfunction has been shown to increase the risk of bacterial translocation from the gut into the pancreatic bed. The primary aim of the study is to evaluate if ileus, a clinical marker of gut barrier dysfunction, can predict the development of IPN.
  
  
  
  A retrospective cohort study of patients with necrotizing pancreatitis (NP) was conducted from 2000 to 2014. Ileus was defined as ≥2 of the following criteria: nausea/vomiting; inability to tolerate a diet, absence of flatus, abdominal distension and features of ileus on imaging. Extensive necrosis was defined as >30% nonenhancing pancreatic parenchyma on contrast-enhanced CT. Multivariable cox proportional hazard analysis was used to evaluate known and potential predictors of IPN.
  
  
  
  142 patients were identified with NP, 61 with IPN and 81 with sterile necrosis. In comparison to a diagnosis of ileus documented in the medical chart, the ileus criteria had a sensitivity, specificity and positive and negative predictive value of 100%, 93%, 78% and 100%, respectively. On multivariate cox proportional hazard analysis, ileus [HR:2.6; 95%CI:1.4-4.9] and extensive necrosis [HR:2.8; 95%CI:1.3-5.8] were independently associated with the development of IPN while there was no association with bacteremia [HR:1.09; 95%CI:0.6-2.1].
  
  
  
  Ileus in NP can be accurately defined using surgical criteria. Ileus is independently associated with the future development of IPN. Further studies will be needed to determine if ileus can serve as a clinical marker to direct therapeutic interventions aimed at reducing the incidence of IPN.
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Moran
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Niloofar Y
authors.initials: NY
authors.lastname: Jalaly
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Kamal
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Klapheke
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Theodore W
authors.initials: TW
authors.lastname: James
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Swetha Kambhampati
authors.initials: SK
authors.lastname: Thiruvengadam
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medical, Baltimore, MD, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medical, Baltimore, MD, USA.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Stein
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Abdominal Imaging, Department of Radiology, Johns Hopkins University School of Medical, Baltimore, MD, USA.
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
authors.affiliation: Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernaez
authors.affiliation: Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D045823:Ileus / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute pancreatitis; Ileus; Infected pancreatic necrosis