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Pancreas
Original article
Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis
  1. Nicolien J Schepers1,
  2. Olaf J Bakker2,
  3. Marc G Besselink3,
  4. Usama Ahmed Ali4,
  5. Thomas L Bollen5,
  6. Hein G Gooszen6,
  7. Hjalmar C van Santvoort2,
  8. Marco J Bruno1
  9. for the Dutch Pancreatitis Study Group
  1. 1 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
  3. 3 Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  4. 4 Department of Surgery, University Medical Center, Utrecht, The Netherlands
  5. 5 Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
  6. 6 Department of Operation Rooms and Evidence Based Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Nicolien J Schepers, Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, 3430EM, The Netherlands; n.schepers{at}antoniusziekenhuis.nl

Abstract

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 and type of organ failure (ie, respiratory, cardiovascular and renal failure) and its association with mortality and infected pancreatic necrosis.

Results In total, 240 of 639 (38%) patients with necrotising pancreatitis developed organ failure. Persistent organ failure (ie, any type or combination) started in the first week in 51% of patients with 42% mortality, in 13% during the second week with 46% mortality and in 36% after the second week with 29% mortality. Mortality in patients with persistent multiple organ failure lasting <1 week, 1–2 weeks, 2–3 weeks or longer than 3 weeks was 43%, 38%, 46% and 52%, respectively (p=0.68). Mortality was higher in patients with organ failure alone than in patients with organ failure and infected pancreatic necrosis (44% vs 29%, p=0.04). However, when excluding patients with very early mortality (within 10 days of admission), patients with organ failure with or without infected pancreatic necrosis had similar mortality rates (28% vs 34%, p=0.33).

Conclusion In patients with necrotising pancreatitis, early persistent organ failure is not associated with increased mortality when compared with persistent organ failure which develops further on during the disease course. Furthermore, no association was found between the duration of organ failure and mortality.

  • acute pancreatitis
  • inflammation
  • pancreas

https://doi.org/10.1136/gutjnl-2017-314657

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    Footnotes

    • Contributors NJS drafted the manuscript in close collaboration with OJB. MGB, UAA, TLB, HGG, HCvanS and MJB coauthored the writing of the manuscript. NJS, OJB, MGB, UAA, TLB and HvanS were involved in the acquisition, analysis and interpretations of data. All authors critically assessed, edited and approved the final manuscript.

    • Funding Dr NJS reports grants from the Dutch Organization for Health Research and Development (ZonMw, grant no. 837002008), grants from Fonds NutsOhra (grant no. 1203-052), outside the submitted work. The sponsors had no involvement in any stage of the study design or analysis and interpretation of the study results. Dr MJB reports grants from Boston Scientific, personal fees from Boston Scientific, grants from Cook Medical, personal fees from Cook Medical, grants from 3M, personal fees from 3M, outside the submitted work. Drs OJB, MGB, UAA, HGG, HCvanS and TLB have nothing to disclose.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The ethics review board of each particating hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data of this research are property of the Dutch Pancreatitis Study Group and therefore not available for third parties. The Dutch Pancreatitis Study Group is willing to consider collaborative research on this topic.