Download PDF
Z Gastroenterol 2016; 54(03): 226-230
DOI: 10.1055/s-0041-106593
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Comorbidity in acute pancreatitis relates to organ failure but not to local complications

Die Komorbidität bei akuter Pankreatitis erhöht das Risiko für Organversagen, aber nicht für lokale Komplikationen
G. Weitz
,
J. Woitalla
,
P. Wellhöner
,
K. J. Schmidt
,
J. Büning
,
K. Fellermann
Further Information

Publication History

23 March 2015

02 September 2015

Publication Date:
04 April 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Objective: Organ failure and local complications contribute to morbidity and mortality in acute pancreatitis. Comorbidity is known to be related to organ failure. The impact of comorbidity on local complications has not yet been delineated. Moreover, it is not clear if the outcome of first-attacks and acute-on-chronic episodes, respectively, differs from outcome in all episodes.

Methods: Consecutive cases of confirmed acute pancreatitis in a four-year period were reviewed. Charlson comorbidity index (CCI), complications (organ failure and local complications), disease severity (according to the revised Atlanta Classification), need for intensive care, and mortality were derived from the charts.

Results: A total of 391 episodes of acute pancreatitis were included. Patients with organ failure were significantly older (P< 0.001) und had a higher CCI (P< 0.001) than patients without organ failure. Patients with and without local complications did not significantly differ in age or CCI. The complication rate of the entire cohort (n = 391; 47.1 %) was comparable with the complication rate of first-attacks (n = 269; 46.8 %) and acute-on-chronic episodes (n = 68; 47.1 %). The majority of the twelve deceased patients had been old and/or chronically ill. Six of these patients had an advanced malignant disease.

Conclusions: Comorbidity and age clearly are contributors to organ failure and mortality. Local complications occur independently of age and concomitant diseases. The overall complication rate is not significantly influenced by preceding inflammation of the pancreas. To further improve care in patients with acute pancreatitis special attention should be given to old and multi-morbid patients.

Zusammenfassung

Hintergrund: Organversagen und lokale Komplikationen tragen zur Morbidität und Mortalität der akuten Pankreatitis bei. Die Komorbidität erhöht das Risiko für Organversagen. Der Einfluss von Komorbidität auf lokale Komplikationen ist nicht bekannt. Außerdem ist nicht bekannt, ob das Outcome von Erstereignissen bzw. Ereignissen auf dem Boden einer chronischen Pankreatitis sich von dem Outcome unterscheidet, wenn alle Ereignisse zusammen betrachtet werden.

Methoden: Es wurden konsekutive Fälle einer bestätigten akuten Pankreatitis in einem Vierjahreszeitraum untersucht. Charlson Comorbidity Index (CCI), Komplikationen (Organversagen und lokale Komplikationen), Schweregrad (nach der revidierten Atlanta-Klassifikation), Intensivpflichtigkeit und Mortalität wurden den Krankenakten entnommen.

Ergebnisse: Insgesamt wurden 391 Ereignisse einer akuten Pankreatitis untersucht. Patienten mit Organversagen waren signifikant älter (P< 0,001) und hatten einen höheren CCI (P< 0,001) als Patienten ohne Organversagen. Patienten mit und ohne lokale Komplikationen unterschieden sich nicht hinsichtlich Alter oder CCI. Die Komplikationsrate der gesamten Kohorte (n = 391; 47,1 %) war vergleichbar mit der Komplikationsrate von Erstereignissen (n = 269; 46,8 %) und Ereignissen auf dem Boden einer chronischen Pankreatitis (n = 68; 47,1 %). Die 12 verstorbenen Patienten waren alt und/oder chronisch krank. Sechs dieser Patienten hatten ein fortgeschrittenes Krebsleiden.

Schlussfolgerung: Komorbidität und Alter sind eindeutige Faktoren, die zu Organversagen und Sterblichkeit bei der akuten Pankreatitis beitragen. Lokale Komplikationen treten unabhängig von Alter und Begleiterkrankungen auf. Die Gesamtrate an Komplikationen hängt nicht wesentlich von vorausgegangenen Entzündungen des Pankreas ab. Zur Verbesserung der Behandlung der akuten Pankreatitis sollte das Augenmerk auf alte und multimorbide Patienten gerichtet werden.

Schlüsselwörter

akute Pankreatitis - Komorbidität - Organversagen - lokale Komplikationen - Mortalität

Key words

acute pancreatitis - comorbidity - organ failure - local complications - mortality
 

  • References

  • 1 Bradley III EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993; 128: 586-590
    CrossrefPubMedGoogle Scholar
  • 2 Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol 2007; 13: 5043-5051
    CrossrefPubMedGoogle Scholar
  • 3 McKay CJ, Buter A. Natural history of organ failure in acute pancreatitis. Pancreatology 2003; 3: 111-114
    CrossrefPubMedGoogle Scholar
  • 4 Vege SS, Chari ST. Organ failure as an indicator of severity of acute pancreatitis: time to revisit the Atlanta classification. Gastroenterology 2005; 128: 1133-1135
    CrossrefPubMedGoogle Scholar
  • 5 Pandol SJ, Saluja AK, Imrie CW et al. Acute pancreatitis: bench to the bedside. Gastroenterology 2007; 132: 1127-1151
    CrossrefPubMedGoogle Scholar
  • 6 Banks PA, Bollen TL, Dervenis C et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedGoogle Scholar
  • 7 Buter A, Imrie CW, Carter CR et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002; 89: 298-302
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Beger HG, Rau B, Isenmann R. Natural history of necrotizing pancreatitis. Pancreatology 2003; 3: 93-101
    PubMedGoogle Scholar
  • 10 Petrov MS, Shanbhag S, Chakraborty M et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010; 139: 813-820
    CrossrefPubMedGoogle Scholar
  • 11 Freeman ML, Werner J, van Santvoort HC et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012; 41: 1176-1194
    CrossrefPubMedGoogle Scholar
  • 12 Frey C, Zhou H, Harvey D 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; 11: 733-742
    CrossrefPubMedGoogle Scholar
  • 13 Mendez-Bailon M, Miguel Yanes JM, Jimenez-Garcia R et al. National trends in incidence and outcomes of acute pancreatitis among type 2 diabetics and non-diabetics in Spain (2001–2011). Pancreatology 2015; 15: 64-70
    CrossrefPubMedGoogle Scholar
  • 14 Carnovale A, Rabitti PG, Manes G et al. Mortality in acute pancreatitis: is it an early or a late event?. JOP 2005; 6: 438-444
    PubMedGoogle Scholar
  • 15 Uomo G, Talamini G, Rabitti PG et al. Influence of advanced age and related comorbidity on the course and outcome of acute pancreatitis. Ital J Gastroenterol Hepatol 1998; 30: 616-621
    PubMedGoogle Scholar
  • 16 Martinez J, Johnson CD, Sanchez-Paya J et al. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology 2006; 6: 206-209
    CrossrefPubMedGoogle Scholar
  • 17 Girman CJ, Kou TD, Cai B et al. Patients with type 2 diabetes mellitus have higher risk for acute pancreatitis compared with those without diabetes. Diabetes Obes Metab 2010; 12: 766-771
    CrossrefPubMedGoogle Scholar
  • 18 Lai SW, Muo CH, Liao KF et al. Risk of acute pancreatitis in type 2 diabetes and risk reduction on anti-diabetic drugs: a population-based cohort study in Taiwan. Am J Gastroenterol 2011; 106: 1697-1704
    CrossrefPubMedGoogle Scholar
  • 19 Sempere L, Martinez J, de Madaria E et al. Obesity and fat distribution imply a greater systemic inflammatory response and a worse prognosis in acute pancreatitis. Pancreatology 2008; 8: 257-264
    CrossrefPubMedGoogle Scholar
  • 20 Wang SQ, Li SJ, Feng QX et al. Overweight is an additional prognostic factor in acute pancreatitis: a meta-analysis. Pancreatology 2011; 11: 92-98
    CrossrefPubMedGoogle Scholar
  • 21 Shen HN, Lu CL, Li CY. Effect of diabetes on severity and hospital mortality in patients with acute pancreatitis: a national population-based study. Diabetes Care 2012; 35: 1061-1066
    CrossrefPubMedGoogle Scholar
  • 22 Akshintala VS, Hutfless SM, Yadav D et al. A population-based study of severity in patients with acute on chronic pancreatitis. Pancreas 2013; 42: 1245-1250
    CrossrefPubMedGoogle Scholar
  • 23 Sandzen B, Rosenmuller M, Haapamaki MM et al. First attack of acute pancreatitis in Sweden 1. BMC Gastroenterol 2009; 9: 18
    CrossrefPubMedGoogle Scholar
  • 24 Omdal T, Dale J, Lie SA et al. Time trends in incidence, etiology, and case fatality rate of the first attack of acute pancreatitis. Scand J Gastroenterol 2011; 46: 1389-1398
    CrossrefPubMedGoogle Scholar
  • 25 Weitz G, Woitalla J, Wellhoner P et al. Detrimental effect of high volume fluid administration in acute pancreatitis – A retrospective analysis of 391 patients. Pancreatology 2014; 14: 478-483
    CrossrefPubMedGoogle Scholar
  • 26 Weitz G, Woitalla J, Wellhoner P et al. Does etiology of acute pancreatitis matter? A review of 391 consecutive episodes. JOP 2015; 16: 171-175
    PubMedGoogle Scholar
  • 27 de Madaria E, Banks PA, Moya-Hoyo N et al. Early factors associated with fluid sequestration and outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol 2014; 12: 997-1002
    CrossrefPubMedGoogle Scholar
  • 28 Buchler MW, Gloor B, Muller CA et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000; 232: 619-626
    CrossrefPubMedGoogle Scholar
  • 29 Mofidi R, Duff MD, Wigmore SJ et al. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 2006; 93: 738-744
    CrossrefPubMedGoogle Scholar
  • 30 Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol 2007; 102: 2688-2695
    CrossrefPubMedGoogle Scholar
  • 31 Rocha FG, Benoit E, Zinner MJ et al. Impact of radiologic intervention on mortality in necrotizing pancreatitis: the role of organ failure. Arch Surg 2009; 144: 261-265
    CrossrefPubMedGoogle Scholar
  • 32 Wall I, Badalov N, Baradarian R et al. Decreased mortality in acute pancreatitis related to early aggressive hydration. Pancreas 2011; 40: 547-550
    CrossrefPubMedGoogle Scholar
  • 33 Warndorf MG, Kurtzman JT, Bartel MJ et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol 2011; 9: 705-709
    CrossrefPubMedGoogle Scholar
  • 34 de Madaria E, Soler-Sala G, Sanchez-Paya J et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol 2011; 106: 1843-1850
    CrossrefPubMedGoogle Scholar
  • 35 Lankisch PG, Karimi M, Bruns A et al. Temporal trends in incidence and severity of acute pancreatitis in Luneburg County, Germany: a population-based study. Pancreatology 2009; 9: 420-426
    CrossrefPubMedGoogle Scholar
  • 36 Satoh K, Shimosegawa T, Masamune A et al. Nationwide epidemiological survey of acute pancreatitis in Japan. Pancreas 2011; 40: 503-507
    CrossrefPubMedGoogle Scholar
  • 37 Singh VK, Bollen TL, Wu BU et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011; 9: 1098-1103
    CrossrefPubMedGoogle Scholar