Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience

Chandraprakash Umapathy, Amit Raina, Shreyas Saligram, Gong Tang, Georgios I. Papachristou, Mordechai Rabinovitz, Jennifer Chennat, Herbert Zeh, Amer H. Zureikat, Melissa E. Hogg, Kenneth K. Lee, Melissa I. Saul, David C. Whitcomb, Adam Slivka, Dhiraj Yadav

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Background: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. Methods: 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. Results: 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. Conclusion: ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.

Original languageEnglish (US)
Pages (from-to)1844-1853
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Keywords

  • Disability
  • Endocrine insufficiency
  • Mortality
  • Necrotizing
  • Pancreatic enzyme replacement therapy
  • Pancreatitis
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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  • Cite this

    Umapathy, C., Raina, A., Saligram, S., Tang, G., Papachristou, G. I., Rabinovitz, M., Chennat, J., Zeh, H., Zureikat, A. H., Hogg, M. E., Lee, K. K., Saul, M. I., Whitcomb, D. C., Slivka, A., & Yadav, D. (2016). Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience. Journal of Gastrointestinal Surgery, 20(11), 1844-1853. https://doi.org/10.1007/s11605-016-3264-2