Organ Failure and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute Pancreatitis

Organ Failure and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute Pancreatitis
Maxim S. Petrov

Affiliations
Reprint requests Address requests for reprints to: Maxim S. Petrov, MD, MPH(Epi), Department of Surgery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. fax: +64-9-377-9656
, Satyanarayan Shanbhag, Mandira Chakraborty, Anthony R.J. Phillips, John A. Windsor
Received 21 January 2010; accepted 3 June 2010. published online 10 June 2010.


Article Outline
Abstract
Methods
Study Identification
Study Selection Criteria
Data Abstraction
Quality Assessment
Statistical Analysis
Results
Study Characteristics and Methodological Quality
Publication Bias Assessment
Overall Patient Characteristics
Influence of Pancreatic Infection on Mortality in Patients With OF
Influence of OF on Mortality in Patients With IPN
Influence of OF vs Pancreatic Infection on Mortality in Patients With Acute Pancreatitis
Discussion
Acknowledgments
References
Copyright

Background & Aims
There is no consistency between the individual studies in the literature on whether organ failure (OF) or infected pancreatic necrosis (IPN) is the main determinant of severity in acute pancreatitis. We aimed to statistically aggregate the available data and determine the pooled influence of OF and IPN on mortality in patients with acute pancreatitis.

Methods
The search for relevant observational studies was undertaken in the MEDLINE, EMBASE, and Scopus electronic databases, as well as in the proceedings of major gastroenterology meetings. The summary estimates are presented as relative risk (RR) and 95% confidence interval (CI).

Results
Fourteen studies comprising 1478 patients with acute pancreatitis were meta-analyzed. A total of 600 patients developed OF and 179 of them died (mortality, 30%); 314 patients developed IPN and 102 of them died (mortality, 32%). In a stratified analysis, patients with OF and IPN had a significantly higher risk of death in comparison with patients with OF and no IPN (RR = 1.94; 95% CI: 1.32−2.85; P = .0007) and in comparison with patients with IPN and no OF (RR = 2.65; 95% CI: 1.30−5.40; P = .0007).

Conclusions
In patients with acute pancreatitis, the absolute influence of OF and IPN on mortality is comparable and thus the presence of either indicates severe disease. The relative risk of mortality doubles when OF and IPN are both present and indicates extremely severe disease or critical acute pancreatitis.

Keywords: Acute Pancreatitis, Organ Failure, Pancreatic Infection, Mortality

Abbreviations used in this paper: CI, confidence interval, IPN, infected pancreatic necrosis, OF, organ failure, RR, relative risk

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http://www.gastrojournal.org/article/S0016-5085(10)00833-4/abstract