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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 11/2016

01-11-2016 | Original Article

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

Authors: 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

Published in: Journal of Gastrointestinal Surgery | Issue 11/2016

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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.
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Metadata
Title
Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience
Authors
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
Publication date
01-11-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 11/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3264-2

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