Co-morbidity is a Strong Predictor of Early Death and Multi-organ System Failure among Patients with Acute Pancreatitis

Abstract

A small but significant percentage of patients with acute pancreatitis die within 2 weeks of hospitalization, usually with multiorgan system failure. To determine the effect of chronic medical comorbidities on early death, we conducted a retrospective analysis of all patients who were hospitalized in California with first-time pancreatitis between 1992 and 2002. Among 84,713 patients, 1514 (1.8%) died within 2 weeks. In a risk-adjusted multivariate model, the strongest predictors of early death were age 65 to 75 years (OR = 2.6, 95% CI: 2.2-3.1 versus <55 years), age over 75 years (OR = 5.2, 95% CI: 4.4-6.1), and the presence of either two chronic comorbid conditions (OR = 3.5, CI: 2.7-4.6) or three or more comorbidities (OR = 7.4, 95% CI: 5.7-9.5). Among the 14,280 patients younger than 55 years who had no chronic comorbid conditions, only 14 (0.1%) died in the first 14 days compared to 701 (5.9%) of 24,852 patients 64 years or older who had three or more comorbidities (RR = 29, 95% CI: 17-50). Comorbid conditions associated with early death included recent cancer, heart failure, renal disease, and liver disease. We conclude that advancing age and the number of chronic comorbid conditions are very strong predictors of early death among patients with acute pancreatitis.

Biliary Pancreatitis : Deadly Threat to the Elderly : Is It a Real Threat ?

“…In our study gallstones were the principal cause of the pancreatitis as evidenced by other studies as well. (23) Our study confirms an association with diabetes mellitus and severity of pancreatitis in elderly males as suggested by other similar studies. (24) Smoking and alcoholism are also found to be a risk factor by Yanng H et al (25) claiming similar association as shown in our study.…”

The Risk Factors of Intensive Care Unit Admittance during First Attack of Acute Pancreatitis

“…Patients with more than 2 accompanying diseases are also at increased risk of ICU treatment. ICU admittance is the worst case scenario for patients with severe acute pancreatitis but the mortality rate amongst ICU patients in this study (24%) is well within the range of reported morbidity and mortality rates (21.0% -53.6%) [5,[24][25][26]. 9% of patients in this cohort are admitted for ICU treatment, which correlates well with a recent study by Shen et al where 10.3% of all patients admitted with their first episode of acute pancreatitis received treatment in an intensive care unit [27].…”

“…The case fatality rate of first episode acute pancreastitis increases with the number of concomitant conditions [24]. Frey et al [24] also show that over 60% of pancreatitis cases have one or more co-morbid conditions, approaching 95% amongst patients with alcohol associated pancreatitis and 40% of these patients have three or more conditions.…”

“…The case fatality rate of first episode acute pancreastitis increases with the number of concomitant conditions [24]. Frey et al [24] also show that over 60% of pancreatitis cases have one or more co-morbid conditions, approaching 95% amongst patients with alcohol associated pancreatitis and 40% of these patients have three or more conditions. The prevalence of concomitant conditions is less in our cohort of patients ( Table 2) and alcohol associated acute pancreatitis occur amongst the youngest patients (Table 4), which tend to have the fewest concomitant conditions (Table 3).…”

Early Achievable SeveritY (EASY) index for simple and accurate early risk stratification in acute pancreatitis

“…It is a challenge to determine the severity of AP during its early stages. Multiple individual risk factors for severe AP have been previously demonstrated including age (>60 years of age) [20], comorbid illnesses (heart failure, chronic renal and liver diseases, cancer) [21], history of chronic alcohol consumption [22] and obesity (BMI >30 kg/m 2 ) [23]. The initial 24 hours of hospitalization are critical in patient management, because the highest incidence of organ dysfunction occurs during this period [24].…”