Clinical outcomes of isolated renal failure compared to other forms of organ failure in patients with severe acute pancreatitis

Abstract

AIMTo assess differences in clinical outcomes of isolated renal failure (RF) compared to other forms of organ failure (OF) in patients with severe acute pancreatitis (SAP).METHODSUsing a prospectively maintained database of patients with acute pancreatitis admitted to a tertiary medical center between 2003 and 2016, those with evidence of persistent OF were classified to renal, respiratory, cardiovascular, or multi-organ (2 or more organs). Data regarding demographics, comorbidities, etiology of acute pancreatitis, and clinical outcomes were prospectively recorded. Differences in clinical outcomes after development of isolated RF in comparison to other forms of OF were determined using independent t and Mann-Whitney U tests for continues variables, and χ2 test for discrete variables.RESULTSAmong 500 patients with acute pancreatitis, 111 patients developed persistent OF: mean age was 54 years, and 75 (67.6%) were male. Forty-three patients had isolated OF: 17 (15.3%) renal, 25 (21.6%) respiratory, and 1 (0.9%) patient with cardiovascular failure. No differences in demographics, etiology of acute pancreatitis, systemic inflammatory response syndrome scores, or development of pancreatic necrosis were seen between patients with isolated RF vs isolated respiratory failure. Patients with isolated RF were less likely to require nutritional support (76.5% vs 96%, P = 0.001), ICU admission (58.8% vs 100%, P = 0.001), and had shorter mean ICU stay (2.4 d vs 15.7 d, P < 0.001), compared to isolated respiratory failure. None of the patients with isolated RF or isolated respiratory failure died.CONCLUSIONAmong patients with SAP per the Revised Atlanta Classification, approximately 15% develop isolated RF. This subgroup seems to have a less protracted clinical course compared to other forms of OF. Isolated RF might be weighed less than isolated respiratory failure in risk predictive modeling of acute pancreatitis.

Development and validation of a predictive model for predicting acute kidney injury in patients with acute pancreatitis

“…As is shown in our study, the overall prevalence of acute kidney injury is 15.5%, in which the incidence of the training set is 16.3%, and the incidence of the validation set is 13.6%, in line with the literature reports [27,28]. This nomogram includes five readily available indices, including BMI, RANSON score, serum uric acid, triglycerides and lactate.…”

Moderately severe and severe acute pancreatitis : a systematic review of the outcomes in the USA and European Union-5

“…Twenty-three studies (12 from the USA and 11 from the EU-5)19 22 24–27 29 30 33 36–48 reporting on economic outcomes related to SAP and MSAP were identified in this review. One study in patients with SAP reported the mean inpatient costs of US$136 730 per patient (cost year not reported (NR)) for those who were transferred to the ICU and did not survive, compared with US$88 434 for those who did survive 22…”

“…More specifically, patients with longer hospital stays were those with the most severe forms of disease. This included patients with peri-PN or PN, IPN (15–21 days in hospital)38 45 compared with those without these complications: (4 days)44; multisystem OF (19–30 days),42 compared with those without (7–9 days)); isolated renal or pulmonary failure (24.7 and 28.8 days, respectively)37 and those requiring admission to the ICU (38–40 days) 22…”

AKI Associated with Acute Pancreatitis

“…AKI develops late in the course of acute pancreatitis, usually after failure of other organs (4,5). Remarkably, the kidney was the first organ to fail in only 8.9% of patients with AKI, and only a minority of patients develop isolated AKI (4,5,9). Retrospective studies reported risk factors for AKI in acute pancreatitis but not the need for kidney replacement therapy (KRT) (3-6).…”