Original article—liver, pancreas, and biliary tract
An Assessment of the Severity of Interstitial Pancreatitis

https://doi.org/10.1016/j.cgh.2011.08.026Get rights and content

Background & Aims

There is limited information on the incidence of and factors associated with severe disease among patients with interstitial pancreatitis (IP). We evaluated a large cohort of patients with IP and compared data with those from patients with extrapancreatic necrosis (EXPN).

Methods

We evaluated 149 consecutive patients with IP admitted over a 2.5-year period. Transferred patients were excluded. We collected data on age, Charlson comorbidity score (CCI), measures of severity on admission or within 24 hours (Acute Physiology and Chronic Health Evaluation II, bedside index for severity of acute pancreatitis scores), persistent (>48 h) systemic inflammatory response syndrome, persistent organ failure, need for intensive care unit, length of hospital stay (in days), and mortality. We also analyzed levels of severity among those with IP and EXPN. Statistical analysis was performed using SAS version 9.1 (Cary, NC).

Results

Among the patients with IP, the median CCI score was 1, the median Acute Physiology and Chronic Health Evaluation II score was 7, and the median bedside index for severity of acute pancreatitis score was 1. In addition, the median length of hospital stay was only 4 days; only 1% had persistent organ failure and only 1% to 2% required intervention. The mortality rate of IP was 3%; it was associated significantly with comorbidity (the median CCI scores of nonsurvivors and survivors was 4 and 1, respectively, P = .003). Patients with EXPN had greater levels of disease severity, compared with patients with IP.

Conclusions

IP is severe in only 1% to 3% of patients; mortality of IP is associated strongly with comorbidity. EXPN is more frequently severe than IP; EXPN must be distinguished from IP in clinical studies.

Section snippets

Methods

The demographic, clinical, laboratory, and radiologic data for all patients directly admitted to our institution with a diagnosis of acute pancreatitis between June 2005 and December 2007 were collected prospectively. All patients transferred from outside institutions were excluded from the study. Patients with radiographic evidence of chronic pancreatitis also were excluded from the study. Among patients with prior or multiple episodes of acute pancreatitis, only the first admission for acute

Results

Figure 1 shows the selection criteria of the study cohort. A total of 306 patients with acute pancreatitis were evaluated. We excluded 54 patients transferred from outside institutions. Among these 54 patients, 23 had NP, 25 had IP, and 6 had EXPN. Of the remaining 252 patients who were admitted directly to our institution, we excluded the 17 patients with an unenhanced computed tomography, 11 patients with NP, and 8 patients with EXPN. Among the 216 remaining patients, 115 underwent a CECT (n

Discussion

Our study systematically evaluated severity of IP in a cohort of consecutive nontransferred patients. We found that IP was a very mild disease in nearly all patients with a median length of stay of only 4 days, persistent organ failure in only 1%, and a mortality rate of only 3%.

Mortality in IP was associated significantly with increased comorbidity, persistent SIRS, and persistent organ failure. It appears that comorbidity played a more important role in mortality than the severity of

References (54)

  • B.U. Wu et al.

    The impact of hospital-acquired infection on outcome in acute pancreatitis

    Gastroenterology

    (2008)
  • M.E. Charlson et al.

    A new method of classifying prognostic comorbidity in longitudinal studies: development and validation

    J Chron Dis

    (1987)
  • L. Rabeneck et al.

    A new clinical prognostic staging system for acute pancreatitis

    Am J Med

    (1993)
  • C. Frey et al.

    Co-morbidity is a strong predictor of early death and multi-organ system failure among patients with acute pancreatitis

    J Gastrointest Surg

    (2007)
  • A. Singla et al.

    Admission volume determines outcome for patients with acute pancreatitis

    Gastroenterology

    (2009)
  • B.U. Wu et al.

    Early hemoconcentration predicts increased mortality only among transferred patients with acute pancreatitis

    Pancreatology

    (2009)
  • R. Elman

    Acute interstitial pancreatitis; clinical study of thirty seven cases showing oedema, swelling, and induration of pancreas without necrosis, hemorrhage, or suppuration

    Surg Gynecol Obstet

    (1933)
  • P.A. Banks et al.

    Practice guidelines in acute pancreatitis

    Am J Gastroenterol

    (2006)
  • A.P. Thal et al.

    A clinical and morphologic study of forty-two cases of fatal acute pancreatitis

    Surg Gynecol Obstet

    (1957)
  • H.W. Evans et al.

    Acute and subacute interstitial pancreatitis: a clinicopathologic study

    Gastroenterology

    (1958)
  • B. Czernobilsky et al.

    The diagnostic significance of interstitial pancreatitis found at autopsy

    Am J Clin Pathol

    (1964)
  • W. Kimura et al.

    Clinical and pathological features of acute interstitial pancreatitis in the aged

    Int J Pancreatol

    (1989)
  • S. Block et al.

    Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging

    Gut

    (1986)
  • H. Jimenez et al.

    Clinical implications derived from the morphological classification of 89 patients with acute pancreatitis

    J Clin Gastroenterol

    (1983)
  • M.A. Shaheen et al.

    Organ failure associated with acute pancreatitis in African-American and Hispanic patients

    J Natl Med Assoc

    (2007)
  • C. Triantopoulou et al.

    Computed tomography versus acute physiology and chronic health evaluation II score in predicting severity of acute pancreatitis: a prospective, comparative study with statistical evaluation

    Pancreas

    (2007)
  • G. Talamini et al.

    Risk of death from acute pancreatitisRole of early, simple “routine” data

    Int J Pancreatol

    (1996)
  • Cited by (133)

    View all citing articles on Scopus

    Conflicts of interest The authors disclose no conflicts.

    Funding This study was supported by a research grant from the National Pancreas Foundation (P.A.B. and V.K.S.).

    View full text