Management and outcomes of acute pancreatitis patients over the last decade: A US tertiary-center experience.
OBJECTIVE
Acute pancreatitis (AP) management remains largely supportive and can be challenging in patients with severe disease. This study aims to describe a ten-year US tertiary-center experience in managing AP patients.


METHODS
Clinical management and outcomes of 400 prospectively enrolled AP patients stratified by the Revised Atlanta Classification were analyzed; trends in management between early (2004-2008) and late enrollment phase (2009-2014) were assessed.


RESULTS
Fifty-two% of patients were classified as mild AP (MAP); moderately severe (MoAP) and severe (SAP) grades contained 23.5% and 24.5% of participants. Intravenous fluid administration during the first 24 h (MAP 3.7, MoAP 4.7, and SAP 4.8 L), need for ICU (6%, 23%, 93%), and nutritional support (7%, 51%, 90%) increased significantly with greater AP severity (p < 0.001). One hundred fifty five (39%) patients developed necrotizing AP, of which 41% received prophylactic antibiotics, and 44% underwent pancreatic drainage/debridement. Prophylactic antibiotics (58% vs. 27%) and interventions (63% vs. 27%) were noted more frequently in SAP than MoAP (p < 0.001). Enteral nutrition (18% vs. 30%) and minimally invasive pancreatic interventions (19% vs. 41%) were more commonly used in the late phase (p < 0.05). The overall median length of hospitalization was 7 days reaching 29 days in SAP group. Mortality was 5%; all deaths occurred in SAP group.


CONCLUSIONS
This study provides an extensive report on clinical management of AP and its trends overtime. Pancreatic intervention is required in less than 50% of patients with necrotizing pancreatitis. Utilization of enteral nutrition and minimally invasive pancreatic interventions has been increasing over time.
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States.
Efstratios
E
Koutroumpakis
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States.
Adam
A
Slivka
Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, United States.
Alessandro
A
Furlan
Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, United States.
Anil K
AK
Dasyam
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, United States.
Anwar
A
Dudekula
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States.
Julia B
JB
Greer
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States.
David C
DC
Whitcomb
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States.
Dhiraj
D
Yadav
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, United States; Division of Gastroenterology, Department of Medicine, Veterans Affairs Pittsburgh Health System, Pittsburgh, PA, United States. Electronic address: papachri@pitt.edu.
Georgios I
GI
Papachristou
D005440:Fluid Therapy; D006801:Humans; D018529:Nutritional Support; D010195:Pancreatitis / Q000453:epidemiology* / Q000628:therapy*; D010956:Plasmapheresis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014481:United States
Acute pancreatitis; Management; Outcomes; Revised Atlanta classification