Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.

Published on Mar 1, 2021in United European gastroenterology journal3.549
· DOI :10.1002/UEG2.12057
Jorge D. Machicado13
Estimated H-index: 13
(Mayo Clinic),
Amir Gougol6
Estimated H-index: 6
(University of Pittsburgh)
+ 28 AuthorsGeorgios I. Papachristou49
Estimated H-index: 49
(University of Pittsburgh)
BACKGROUND Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. OBJECTIVE We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. METHODS We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders. RESULTS 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality. CONCLUSION In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.
#1Bassem Matta (University of Pittsburgh)H-Index: 5
#2Amir Gougol (University of Pittsburgh)H-Index: 6
Last. Georgios I. Papachristou (OSU: Ohio State University)H-Index: 49
view all 29 authors...
Abstract Background & Aims Few studies have compared regional differences in acute pancreatitis. We analyzed data from an international registry of patients with acute pancreatitis to evaluate geographic variations in patient characteristics, management, and outcomes. Methods We collected data from the APPRENTICE registry of patients with acute pancreatitis, which obtains information from patients in Europe (6 centers), India (3 centers), Latin America (5 centers), and North America (8 centers) ...
13 CitationsSource
#1Na Shi (Sichuan University)H-Index: 8
#2Tingting LiuH-Index: 8
Last. Robert Sutton (University of Liverpool)H-Index: 56
view all 15 authors...
We read with great interest the recent Gut publication by Schepers et al 1 reporting no association between the time of onset or duration of persistent organ failure (POF, >48 hours, distinguished from transient organ failure second week) caused by infected pancreatic necrosis (IPN).2 Patients with early fulminant POF have been considered to have a higher mortality than those developing POF later,3–6 and those with POF in combination with IPN to have a higher mortality than those with POF alone....
19 CitationsSource
#1Hanna Sternby (Lund University)H-Index: 6
#2Federico BoladoH-Index: 3
Last. Enrique de-MadariaH-Index: 18
view all 28 authors...
Objective:The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes.Summary of Background Data:AP is a heterogeneous disease, ranging from uneventfu
27 CitationsSource
#1Nicolien J. Schepers (EUR: Erasmus University Rotterdam)H-Index: 12
#2Olaf J. BakkerH-Index: 33
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 67
view all 8 authors...
Objective In patients with pancreatitis, early persisting organ failure is believed to be the most important cause of mortality. This study investigates the relation between the timing (onset and duration) of organ failure and mortality and its association with infected pancreatic necrosis in patients with necrotising pancreatitis. Design We performed a post hoc analysis of a prospective database of 639 patients with necrotising pancreatitis from 21 hospitals. We evaluated the onset, duration an...
56 CitationsSource
#1Kalpit Devani (ETSU: East Tennessee State University)H-Index: 6
#2Paris Charilaou (RU: Rutgers University)H-Index: 14
Last. Chakradhar Reddy (ETSU: East Tennessee State University)H-Index: 9
view all 6 authors...
Abstract Objectives To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. Methods We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with s...
11 CitationsSource
#1Rajesh PadhanH-Index: 7
#2Saransh JainH-Index: 9
Last. Pramod Kumar GargH-Index: 48
view all 11 authors...
OBJECTIVE: The aim of this study was to study the development of early and late organ failure (OF) and their differential impact on mortality in patients with acute pancreatitis (AP). METHODS: Consecutive patients (N = 805) with acute pancreatitis were included in an observational study. Organ failure was categorized as primary if it occurred early due to pancreatitis per se and secondary if it occurred late due to infected pancreatic necrosis (IPN). Primary outcome was a relative contribution o...
18 CitationsSource
#1Amir Gougol (University of Pittsburgh)H-Index: 6
#2Mohannad Dugum (University of Pittsburgh)H-Index: 6
Last. Georgios I. Papachristou (University of Pittsburgh)H-Index: 49
view all 8 authors...
Clinical outcomes of isolated renal failure compared to other forms of organ failure in patients with severe acute pancreatitis
9 CitationsSource
#1Ayesha Kamal (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 10
#2Amitasha Sinha (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 9
Last. Vikesh K. Singh (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 48
view all 12 authors...
Abstract Background Multiple factors influence mortality in Acute Pancreatitis (AP). Methods To evaluate the association of demographic, clinical, and hospital factors with the in-hospital mortality of AP using a population-based administrative database. The Maryland HSCRC database was queried for adult (≥18 years) admissions with primary diagnosis of AP between 1/94-12/10. Organ failure (OF), interventions, hospital characteristics and referral status were evaluated. Results There were 72,601 A...
4 CitationsSource
#1Georgios I. Papachristou (University of Pittsburgh)H-Index: 49
#2Jorge D. Machicado (University of Pittsburgh)H-Index: 13
Last. Amir Gougol (University of Pittsburgh)H-Index: 6
view all 33 authors...
Background We have established a multicenter international consortium to better understand the natural history of acute pancreatitis (AP) worldwide and to develop a platform for future randomized clinical trials. Methods The AP patient registry to examine novel therapies in clinical experience (APPRENTICE) was formed in July 2014. Detailed web-based questionnaires were then developed to prospectively capture information on demographics, etiology, pancreatitis history, comorbidities, risk factors...
22 CitationsSource
#1Mengyang DiH-Index: 11
#2Hao LiuH-Index: 1
Last. Joseph LauH-Index: 159
view all 6 authors...
Acute pancreatitis (AP) varies in severity, prompting development of systems aimed at predicting prognosis to help guide therapy. Although several prediction approaches are available, their test characteristics and clinical utility are not completely understood.To evaluate the test characteristics (prognostic accuracy, incremental predictive value) and clinical utility (effect on patient outcomes) of severity scores for predicting mortality in AP.Ovid MEDLINE and EMBASE (inception to 3 May 2016)...
27 CitationsSource
Cited By0