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Annals of Surgery:
doi: 10.1097/SLA.0000000000000264
Original Article: PDF Only

The Role of Organ Failure and Infection in Necrotizing Pancreatitis: A Prospective Study

Guo, Qiang MD; Li, Ang MD; Xia, Qing MD; Liu, Xubao MD; Tian, Bole MD; Mai, Gang MD; Huang, Zongwen MD; Chen, Guangyuan MD; Tang, Wenfu MD; Jin, Xiaodong MD; Chen, Weixia MD; Lu, Huimin MD; KE, Nengwen MD; Zhang, Zhaoda MD; HU, Weiming MD

Published Ahead-of-Print
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Abstract

Objective: To clarify the roles of organ failure and infection in the outcome of necrotizing pancreatitis.

Background: Results of previous cohort studies that focused on the roles of infection and organ failure in acute pancreatitis are controversial.

Methods: In this study, we collected the medical records of 447 patients with necrotizing pancreatitis from January 2009 to June 2012. Data associated with organ failure and infection were analyzed.

Results: The overall mortality rate was 13% (58/447). Intervention was performed in 223 of 447 patients. Among these 223 patients, 134 were confirmed to be with infected necrosis by a positive culture. The mortality rate was 15% (13/89) in the sterile necrosis group and 18% (24/134) in the infected necrosis group (P = 0.52). A multivariate analysis of death predictors indicated that bacteremia (odds ratio [OR] = 2.76, 95% confidence interval [CI], 1.23-5.46, P < 0.001), age (OR = 1.07, 95% CI, 1.03-1.11, P < 0.001), American Society of Anesthesiologists class (OR = 3.56, 95% CI, 1.65-7.18, P = 0.001), persistent organ failure in the first week (OR = 16.72, 95% CI, 7.04-32.56, P < 0.001), and pancreatic necrosis (OR = 1.73, 95% CI, 1.14-2.98, P = 0.008) were significant factors.

Conclusions: Among patients with necrotizing pancreatitis, the effects of organ failure on mortality are more critical than those of infection. Bacteremia, age, American Society of Anesthesiologists class, persistent organ failure in the first week, and pancreatic necrosis were identified as the predictors of mortality.

(C) 2014 by Lippincott Williams & Wilkins.

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