A systematic review of the extra-pancreatic infectious complications in acute pancreatitis

Brown, Lisa; Hore, Todd; Phillips, Anthony R.J.; Windsor, John A.; Petrov, Maxim S.

doi:10.1016/j.pan.2014.09.010

Cited by 51 publications

(41 citation statements)

References 50 publications

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“…To date, infectious extra-pancreatic complications have been reported in patients hospitalized with AP, but not specifically in patients admitted to the ICU. In a systematic review, Brown et al compiled 1700 patients admitted for AP from 19 studies and reported an incidence rate of 32%, with the most common infections being respiratory infections, blood-stream infection and urinary-tract infections [ 9 ]. Similarly, our study found that respiratory infections, blood-stream infection and urinary-tract infections were the most common infectious extra-pancreatic complications in patients admitted with AP to the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…The mortality from severe AP is approximately 30%, but may be as high as 47% in patients with persistent multi-organ system dysfunction and/or infected necrosis [ 5–8 ]. Additionally, the presence of extra-pancreatic complications contributes to morbidity and mortality [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Broadly, extra-pancreatic complications can be divided into infectious events and non-infectious events. Infectious extra-pancreatic complications have been previously reported in patients hospitalized with AP but not specifically in patients admitted to ICUs [ 9 , 10 ]. Moreover, non-infectious extra-pancreatic complications have not been explored in this population.…”

Section: Introductionmentioning

confidence: 99%

“…A systematic review reported the incidence of infectious extra-pancreatic complications as 32% [ 9 ]. Further, in 2008, one population-based study explored the impact of hospital-acquired infections on outcomes for all patients diagnosed with AP.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Kothari

Struyvenberg

Perillo

et al. 2018

Gastroenterology Report

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Background and aimsPatients in the intensive care unit (ICU) with acute pancreatitis (AP) are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay. We sought to determine the rate of extra-pancreatic complications and its effect on length of stay (LOS) and mortality in ICU patients with AP.MethodsWe performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP. A total of 287 ICU patients had a discharge diagnosis of AP, of which 163 met inclusion criteria. We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality.ResultsThere were a total of 158 extra-pancreatic complications (0.97 extra-pancreatic complications per patient). Ninety-five patients had at least one extra-pancreatic complication, whereas 68 patients had no extra-pancreatic complications. Patients with extra-pancreatic complications had a significantly longer LOS (14.7 vs 8.8 days, p < 0.01) when controlling for local pancreatic complications. Patients with non-infectious extra-pancreatic complications had a higher rate of mortality (24.0% vs 16.2%, p = 0.04). Patients requiring dialysis was an independent predictor for LOS and mortality (incidence risk ratio [IRR] 1.73, 95% confidence interval [CI]: 1.263–2.378 and IRR 1.50, 95% CI 1.623–6.843, p < 0.01) on multi-variable analysis. Coronary events were also a predictor for mortality (p = 0.05). Other extra-pancreatic complications were not significant.ConclusionsExtra-pancreatic complications occur frequently in ICU patients with AP and impact LOS. Patients with non-infectious extra-pancreatic complications have a higher mortality rate. After controlling for local pancreatic complications, patients requiring dialysis remained an independent predictor for LOS and mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Kothari

Struyvenberg

Perillo

et al. 2018

Gastroenterology Report

View full text Add to dashboard Cite

show abstract

“…Infections, such as bacteraemia, pneumonia, and urinary tract infection, can also occur in extrapancreatic sites [ 13 ]. Moreover, the presence of extrapancreatic complications contributes to morbidity and mortality [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

et al. 2020

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Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP). Methods: We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed. Results: In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001). Conclusion: Clinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.

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Locoregional pathophysiology in acute pancreatitis: pancreas and intestine

2017

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A systematic review of the extra-pancreatic infectious complications in acute pancreatitis

Cited by 51 publications

References 50 publications

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis

The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

Locoregional pathophysiology in acute pancreatitis: pancreas and intestine

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