Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 6/2007

01-06-2007

Co-morbidity is a Strong Predictor of Early Death and Multi-organ System Failure among Patients with Acute Pancreatitis

Authors: Charles Frey, MD, Hong Zhou, PhD, Danielle Harvey, PhD, Richard H. White, MD

Published in: Journal of Gastrointestinal Surgery | Issue 6/2007

Login to get access

Abstract

A small but significant percentage of patients with acute pancreatitis die within 2 weeks of hospitalization, usually with multiorgan system failure. To determine the effect of chronic medical comorbidities on early death, we conducted a retrospective analysis of all patients who were hospitalized in California with first-time pancreatitis between 1992 and 2002. Among 84,713 patients, 1514 (1.8%) died within 2 weeks. In a risk-adjusted multivariate model, the strongest predictors of early death were age 65 to 75 years (OR = 2.6, 95% CI: 2.2–3.1 versus <55 years), age over 75 years (OR = 5.2, 95% CI: 4.4–6.1), and the presence of either two chronic comorbid conditions (OR = 3.5, CI: 2.7–4.6) or three or more comorbidities (OR = 7.4, 95% CI: 5.7–9.5). Among the 14,280 patients younger than 55 years who had no chronic comorbid conditions, only 14 (0.1%) died in the first 14 days compared to 701 (5.9%) of 24,852 patients 64 years or older who had three or more comorbidities (RR = 29, 95% CI: 17–50). Comorbid conditions associated with early death included recent cancer, heart failure, renal disease, and liver disease. We conclude that advancing age and the number of chronic comorbid conditions are very strong predictors of early death among patients with acute pancreatitis.
Appendix
Available only for authorised users
Literature
1.
go back to reference Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565–573.PubMedCrossRef Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565–573.PubMedCrossRef
2.
go back to reference Eland IA, Sturkenboom MC, van der Lei J, Wilson JH, Stricker BH. Incidence of acute pancreatitis. Scand J Gastroenterol 2002;37:124.PubMedCrossRef Eland IA, Sturkenboom MC, van der Lei J, Wilson JH, Stricker BH. Incidence of acute pancreatitis. Scand J Gastroenterol 2002;37:124.PubMedCrossRef
3.
go back to reference Floyd A, Pedersen L, Nielsen GL, Thorladcius-Ussing O, Sorensen HT. Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland County, Denmark: a register-based study from 1981 to 2000. Scand J Gastroenterol 2002;37:1461–1465.PubMedCrossRef Floyd A, Pedersen L, Nielsen GL, Thorladcius-Ussing O, Sorensen HT. Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland County, Denmark: a register-based study from 1981 to 2000. Scand J Gastroenterol 2002;37:1461–1465.PubMedCrossRef
4.
go back to reference Gullo L, Migliori M, Olah A, et al. Acute pancreatitis in five European countries: etiology and mortality. Pancreas 2002;24:223–227.PubMedCrossRef Gullo L, Migliori M, Olah A, et al. Acute pancreatitis in five European countries: etiology and mortality. Pancreas 2002;24:223–227.PubMedCrossRef
5.
go back to reference Gislason H, Horn A, Hoem D, et al. Acute pancreatitis in Bergen, Norway. A study on incidence, etiology and severity. Scand J Surg 2004;93:29–33.PubMed Gislason H, Horn A, Hoem D, et al. Acute pancreatitis in Bergen, Norway. A study on incidence, etiology and severity. Scand J Surg 2004;93:29–33.PubMed
6.
go back to reference Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality. BMJ 2004;328:1466–1469.PubMedCrossRef Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality. BMJ 2004;328:1466–1469.PubMedCrossRef
7.
go back to reference Andersson R, Andren-Sandberg A. Fatal acute pancreatitis. Characteristics of patients never reaching hospital. Pancreatology 2003;3:64–66.PubMedCrossRef Andersson R, Andren-Sandberg A. Fatal acute pancreatitis. Characteristics of patients never reaching hospital. Pancreatology 2003;3:64–66.PubMedCrossRef
8.
go back to reference Mutinga M, Rosenbluth A, Tenner SM, Odze RR, Sica GT, Banks PA. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol 2000;28:91–95.PubMed Mutinga M, Rosenbluth A, Tenner SM, Odze RR, Sica GT, Banks PA. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol 2000;28:91–95.PubMed
9.
go back to reference Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;53:1340–1344.PubMedCrossRef Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;53:1340–1344.PubMedCrossRef
10.
go back to reference McKay CJ, Evans S, Sinclair M, Carter CR, Imrie CW. High early mortality rate from acute pancreatitis in Scotland, 1984–1995. Br J Surg 1999;86:1302–1305.PubMedCrossRef McKay CJ, Evans S, Sinclair M, Carter CR, Imrie CW. High early mortality rate from acute pancreatitis in Scotland, 1984–1995. Br J Surg 1999;86:1302–1305.PubMedCrossRef
11.
go back to reference Lowham A, Lavelle J, Leese T. Mortality from acute pancreatitis. Late septic deaths can be avoided but some early deaths still occur. Int J Pancreatol 1999;25:103–106.PubMed Lowham A, Lavelle J, Leese T. Mortality from acute pancreatitis. Late septic deaths can be avoided but some early deaths still occur. Int J Pancreatol 1999;25:103–106.PubMed
12.
go back to reference Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG. Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 2001;1:237–241.PubMedCrossRef Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG. Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 2001;1:237–241.PubMedCrossRef
13.
go back to reference Gloor B, Muller CA, Worni M, Martignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975–979.PubMedCrossRef Gloor B, Muller CA, Worni M, Martignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975–979.PubMedCrossRef
14.
go back to reference Halonen KI, Leppaniemi AK, Lundin JE, Puolakkainen PA, Kemppainen EA, Haapiainen RK. Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models. Pancreatology 2003;3:309–315.PubMedCrossRef Halonen KI, Leppaniemi AK, Lundin JE, Puolakkainen PA, Kemppainen EA, Haapiainen RK. Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models. Pancreatology 2003;3:309–315.PubMedCrossRef
15.
go back to reference Poves Prim I, Fabregat Pous J, Garcia Borobia FJ, Jorba Marti R, Figueras Felip J, Jaurrieta Mas E. Early onset of organ failure is the best predictor of mortality in acute pancreatitis. Rev Esp Enferm Dig 2004;96:705–709;709–713.PubMedCrossRef Poves Prim I, Fabregat Pous J, Garcia Borobia FJ, Jorba Marti R, Figueras Felip J, Jaurrieta Mas E. Early onset of organ failure is the best predictor of mortality in acute pancreatitis. Rev Esp Enferm Dig 2004;96:705–709;709–713.PubMedCrossRef
16.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.PubMedCrossRef Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.PubMedCrossRef
17.
go back to reference Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139:69–81.PubMed Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139:69–81.PubMed
18.
go back to reference Imrie CW, Ferguson JC, Murphy D, Blumgart LH. Arterial hypoxia in acute pancreatitis. Br J Surg 1977;64:185–188.PubMedCrossRef Imrie CW, Ferguson JC, Murphy D, Blumgart LH. Arterial hypoxia in acute pancreatitis. Br J Surg 1977;64:185–188.PubMedCrossRef
19.
go back to reference Triester SL, Kowdley KV. Prognostic factors in acute pancreatitis. J Clin Gastroenterol 2002;34:167–176.PubMedCrossRef Triester SL, Kowdley KV. Prognostic factors in acute pancreatitis. J Clin Gastroenterol 2002;34:167–176.PubMedCrossRef
20.
go back to reference Sandberg AA, Borgstrom A. Early prediction of severity in acute pancreatitis. Is this possible? Jop 2002;3:116–125.PubMed Sandberg AA, Borgstrom A. Early prediction of severity in acute pancreatitis. Is this possible? Jop 2002;3:116–125.PubMed
21.
go back to reference Rettally CA, Skarda S, Garza MA, Schenker S. The usefulness of laboratory tests in the early assessment of severity of acute pancreatitis. Crit Rev Clin Lab Sci 2003;40:117–149.PubMed Rettally CA, Skarda S, Garza MA, Schenker S. The usefulness of laboratory tests in the early assessment of severity of acute pancreatitis. Crit Rev Clin Lab Sci 2003;40:117–149.PubMed
22.
go back to reference Dervenis C, Johnson CD, Bassi C, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol 1999;25:195–210.PubMed Dervenis C, Johnson CD, Bassi C, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol 1999;25:195–210.PubMed
23.
go back to reference Lankisch PG, Burchard-Reckert S, Petersen M, et al. Etiology and age have only a limited influence on the course of acute pancreatitis. Pancreas 1996;13:344–349.PubMedCrossRef Lankisch PG, Burchard-Reckert S, Petersen M, et al. Etiology and age have only a limited influence on the course of acute pancreatitis. Pancreas 1996;13:344–349.PubMedCrossRef
24.
go back to reference Paajanen H, Jaakkola M, Oksanen H, Nordback I. Acute pancreatitis in patients over 80 years. Eur J Surg 1996;162:471–475.PubMed Paajanen H, Jaakkola M, Oksanen H, Nordback I. Acute pancreatitis in patients over 80 years. Eur J Surg 1996;162:471–475.PubMed
25.
go back to reference Lankisch PG, Blum T, Maisonneuve P, Lowenfels AB. Severe acute pancreatitis: when to be concerned? Pancreatology 2003;3:102–110.PubMedCrossRef Lankisch PG, Blum T, Maisonneuve P, Lowenfels AB. Severe acute pancreatitis: when to be concerned? Pancreatology 2003;3:102–110.PubMedCrossRef
26.
go back to reference Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291:2441–2447.PubMedCrossRef Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291:2441–2447.PubMedCrossRef
27.
go back to reference Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 2001;285:885–892.PubMedCrossRef Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 2001;285:885–892.PubMedCrossRef
28.
go back to reference Yancik R, Wesley MN, Ries LA, et al. Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer 1998;82:2123–2134.PubMedCrossRef Yancik R, Wesley MN, Ries LA, et al. Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer 1998;82:2123–2134.PubMedCrossRef
29.
go back to reference Ouellette JR, Small DG, Termuhlen PM. Evaluation of Charlson-age comorbidity index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg 2004;8:1061–1067.PubMedCrossRef Ouellette JR, Small DG, Termuhlen PM. Evaluation of Charlson-age comorbidity index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg 2004;8:1061–1067.PubMedCrossRef
30.
go back to reference Ogle KS, Swanson GM, Woods N, Azzouz F. Cancer and comorbidity: redefining chronic diseases. Cancer 2000;88:653–663.PubMedCrossRef Ogle KS, Swanson GM, Woods N, Azzouz F. Cancer and comorbidity: redefining chronic diseases. Cancer 2000;88:653–663.PubMedCrossRef
31.
go back to reference Romano PS, Chan BK. Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? Health Serv Res 2000;34:1469–1489.PubMed Romano PS, Chan BK. Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? Health Serv Res 2000;34:1469–1489.PubMed
32.
go back to reference Marcin JP, Romano PS. Impact of between-hospital volume and within-hospital volume on mortality and readmission rates for trauma patients in California. Crit Care Med 2004;32:1477–1483.PubMedCrossRef Marcin JP, Romano PS. Impact of between-hospital volume and within-hospital volume on mortality and readmission rates for trauma patients in California. Crit Care Med 2004;32:1477–1483.PubMedCrossRef
33.
go back to reference Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.PubMedCrossRef Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.PubMedCrossRef
35.
go back to reference Glance LG, Dick AW, Osler TM, Mukamel DB. Does date stamping ICD-9-CM codes increase the value of clinical information in administrative data? Health Serv Res 2006;41:231–251.PubMedCrossRef Glance LG, Dick AW, Osler TM, Mukamel DB. Does date stamping ICD-9-CM codes increase the value of clinical information in administrative data? Health Serv Res 2006;41:231–251.PubMedCrossRef
36.
go back to reference Stukenborg GJ, Wagner DP, Connors AF Jr. Comparison of the performance of two comorbidity measures, with and without information from prior hospitalizations. Med Care 2001;39:727–739.PubMedCrossRef Stukenborg GJ, Wagner DP, Connors AF Jr. Comparison of the performance of two comorbidity measures, with and without information from prior hospitalizations. Med Care 2001;39:727–739.PubMedCrossRef
37.
go back to reference Humphries KH, Rankin JM, Carere RG, Buller CE, Kiely FM, Spinelli JJ. Co-morbidity data in outcomes research: are clinical data derived from administrative databases a reliable alternative to chart review? J Clin Epidemiol 2000;53:343–349.PubMedCrossRef Humphries KH, Rankin JM, Carere RG, Buller CE, Kiely FM, Spinelli JJ. Co-morbidity data in outcomes research: are clinical data derived from administrative databases a reliable alternative to chart review? J Clin Epidemiol 2000;53:343–349.PubMedCrossRef
38.
go back to reference Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care 2002;40:675–685.PubMedCrossRef Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care 2002;40:675–685.PubMedCrossRef
39.
go back to reference Sands KE, Bates DW, Lanken PN, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 1997;278:234–240.PubMedCrossRef Sands KE, Bates DW, Lanken PN, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 1997;278:234–240.PubMedCrossRef
40.
go back to reference Gollin G, Zieg PM, Cohn SM, Lieberman JM, Marks WH. Intestinal mucosal injury in critically ill surgical patients: preliminary observations. Am Surg 1999;65:19–21.PubMed Gollin G, Zieg PM, Cohn SM, Lieberman JM, Marks WH. Intestinal mucosal injury in critically ill surgical patients: preliminary observations. Am Surg 1999;65:19–21.PubMed
41.
go back to reference Rahman SH, Ammori BJ, Holmfield J, Larvin M, McMahon MJ. Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis. J Gastrointest Surg 2003;7:26–35; discussion 35–26.PubMedCrossRef Rahman SH, Ammori BJ, Holmfield J, Larvin M, McMahon MJ. Intestinal hypoperfusion contributes to gut barrier failure in severe acute pancreatitis. J Gastrointest Surg 2003;7:26–35; discussion 35–26.PubMedCrossRef
42.
go back to reference Hirota M, Inoue K, Kimura Y, et al. Non-occlusive mesenteric ischemia and its associated intestinal gangrene in acute pancreatitis. Pancreatology 2003;3:316–322.PubMedCrossRef Hirota M, Inoue K, Kimura Y, et al. Non-occlusive mesenteric ischemia and its associated intestinal gangrene in acute pancreatitis. Pancreatology 2003;3:316–322.PubMedCrossRef
43.
go back to reference Pates RD, Scully KW, Einbinder JS, et al. Adding value to clinical data by linkage to a public death registry. Medinfo 2001;10:1384–1388.PubMed Pates RD, Scully KW, Einbinder JS, et al. Adding value to clinical data by linkage to a public death registry. Medinfo 2001;10:1384–1388.PubMed
44.
go back to reference Frey CF, Zhou H, Harvey D, White RH. The incidence and case-fatality rate of acute biliary, alcoholic and idiopathic pancreatitis in California, 1994–2001. Pancreas 2006;33:336–344.PubMedCrossRef Frey CF, Zhou H, Harvey D, White RH. The incidence and case-fatality rate of acute biliary, alcoholic and idiopathic pancreatitis in California, 1994–2001. Pancreas 2006;33:336–344.PubMedCrossRef
45.
go back to reference Parker JP, Li Z, Damberg CL, Danielsen B, Carlisle DM. Administrative versus clinical data for coronary artery bypass graft surgery report cards: the view from California. Med Care 2006;44:687–695.PubMedCrossRef Parker JP, Li Z, Damberg CL, Danielsen B, Carlisle DM. Administrative versus clinical data for coronary artery bypass graft surgery report cards: the view from California. Med Care 2006;44:687–695.PubMedCrossRef
46.
go back to reference Eland IA, Sturkenboom MJ, Wilson JH, Stricker BH. Incidence and mortality of acute pancreatitis between 1985 and 1995. Scand J Gastroenterol 2000;35:1110–1116.PubMedCrossRef Eland IA, Sturkenboom MJ, Wilson JH, Stricker BH. Incidence and mortality of acute pancreatitis between 1985 and 1995. Scand J Gastroenterol 2000;35:1110–1116.PubMedCrossRef
47.
go back to reference Company L, Saez J, Martinez J, et al. Factors predicting mortality in severe acute pancreatitis. Pancreatology 2003;3:144–148.PubMedCrossRef Company L, Saez J, Martinez J, et al. Factors predicting mortality in severe acute pancreatitis. Pancreatology 2003;3:144–148.PubMedCrossRef
48.
go back to reference Melfi C, Holleman E, Arthur D, Katz B. Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data. J Clin Epidemiol 1995;48:917–926.PubMedCrossRef Melfi C, Holleman E, Arthur D, Katz B. Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data. J Clin Epidemiol 1995;48:917–926.PubMedCrossRef
49.
go back to reference Wang PS, Walker A, Tsuang M, Orav EJ, Levin R, Avorn J. Strategies for improving comorbidity measures based on Medicare and Medicaid claims data. J Clin Epidemiol 2000;53:571–578.PubMedCrossRef Wang PS, Walker A, Tsuang M, Orav EJ, Levin R, Avorn J. Strategies for improving comorbidity measures based on Medicare and Medicaid claims data. J Clin Epidemiol 2000;53:571–578.PubMedCrossRef
Metadata
Title
Co-morbidity is a Strong Predictor of Early Death and Multi-organ System Failure among Patients with Acute Pancreatitis
Authors
Charles Frey, MD
Hong Zhou, PhD
Danielle Harvey, PhD
Richard H. White, MD
Publication date
01-06-2007
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 6/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-007-0164-5

Other articles of this Issue 6/2007

Journal of Gastrointestinal Surgery 6/2007 Go to the issue