Admission, management and outcomes of acute pancreatitis in intensive care

Russell, Peter; Mittal, Anhubav; Brown, Lisa; McArthur, Colin; Phillips, Anthony; Petrov, Maxim S.; Windsor, John A.

doi:10.1111/ans.13498

Cited by 10 publications

(7 citation statements)

References 32 publications

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“…Higher mortality rates have been observed in Maori populations with cancer 8–10 and inpatient diabetics 11 . There is limited literature regarding outcomes of AP in indigenous populations; however, Maori and indigenous Australians are over‐represented in literature regarding severe pancreatitis 12,13 . Approximately half the population of Northland, New Zealand, live outside a main urban centre and 38% are Maori 14,15 .…”

Section: Introductionmentioning

confidence: 99%

“…Approximately half the population of Northland, New Zealand, live outside a main urban centre and 38% are Maori 14,15 . A small number of studies have addressed the management and outcomes of AP in New Zealand 12,16–19 . No previous studies have specifically examined differences in presentation and outcomes of rural or Maori patients with AP.…”

Section: Introductionmentioning

confidence: 99%

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Effect of rurality and ethnicity in severity and outcomes in patients with acute pancreatitis

Birrell

McGuinness

Elliott

et al. 2021

ANZ Journal of Surgery

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Background Previous studies have demonstrated a high incidence of acute pancreatitis (AP) in New Zealand, with Maori having the highest reported incidence worldwide. It is possible that barriers to healthcare exist for rural and Maori patients, leading to poorer outcomes. The aim of this study is to compare differences in severity and outcomes in patients with AP with regards to rurality and ethnicity. Methods Multicentre retrospective study of all adults aged >16 years who were admitted to any hospital with AP in Northland between 1 January 2014 and 31 December 2018 was performed. Pancreatitis severity was classified using the Revised Atlanta classification. The primary outcome of interest was the difference in severity of pancreatitis with regards to rurality and ethnicity. Secondary outcomes of interest included clinical outcomes, aetiology of AP and re‐presentation rates. Results A total of 468 patients were included. There was no difference found between rural and urban or Maori and non‐Maori patients with regards to disease severity, length of stay, mortality or intensive care unit admission rate. A significant difference in aetiology was found between Maori and non‐Maori patients, with a higher rate of gallstone pancreatitis in Maori. There was no difference in local complications or number of re‐presentations between groups. Conclusion This study showed no difference in the severity or outcomes of AP across rural and urban patients in the Northland region of New Zealand. Secondary outcomes were broadly comparable between groups, with a higher rate of gallstone pancreatitis found in Maori compared to non‐Maori.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of rurality and ethnicity in severity and outcomes in patients with acute pancreatitis

Birrell

McGuinness

Elliott

et al. 2021

ANZ Journal of Surgery

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“…These include the Ranson, [ 19 ] Acute Physiology and Chronic Health Assessment (APACHE) II and III, [ 5 , 20 , 21 ] and Sequential Organ Failure Assessment (SOFA) scoring systems. [ 22 – 27 ] However, scoring only a single time ignores many factors that can influence the outcome during the course of the illness. The measurements from these scoring systems have been shown to more effectively represent the dynamic changes of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis

Tee

Fang²,

Kuo³

et al. 2018

Medicine

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Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7.4%) patients, while late mortality occurred in 17 (12.6%).All scoring systems were reliable for predicting overall and intensive care unit mortality, while the SOFA score on day 7 presented the largest area under the receiver operator characteristic (ROC) curve (0.858, SE 0.055). Changes in scores over time were evaluated for predicting the progression of organ failure, and the change in SOFA score on hospital day 7 or no interval change in SOFA score was associated with higher mortality rates.APACHE II and SOFA scores are both sensitive for predicting mortality in acute pancreatitis. The serial SOFA scores showed reliable for predicting mortality. Hospital day 7 is a reasonable time for SOFA score reassessment to predict late mortality in acute severe pancreatitis.

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“…Previous smaller studies have identified inequities for M aori in NZ requiring critical care for specific presentations, including necrotising fasciitis, 42 acute pancreatitis, 14 trauma 11 and influenza 43 among adults, and Staphylococcus aureus sepsis, 44 pedestrian injuries 45 and severe varicella zoster infection 46 in children.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Previous literature has identified inequity in critical illness admissions for M aori, including trauma, 10,11 stroke 12 and severe infections. 13,14 There is, however, no literature describing M aori health outcomes in a general intensive care unit (ICU) population not specified to a type of presentation.…”

Section: Introductionmentioning

confidence: 99%

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

Slim

Lala

Barnes

et al. 2021

Anaesth Intensive Care

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Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

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Admission, management and outcomes of acute pancreatitis in intensive care

Abstract: There have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved.

Cited by 10 publications

References 32 publications

Effect of rurality and ethnicity in severity and outcomes in patients with acute pancreatitis

Effect of rurality and ethnicity in severity and outcomes in patients with acute pancreatitis

Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

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