Effect of Obesity and Decompressive Laparotomy on Mortality in Acute Pancreatitis Requiring Intensive Care Unit Admission

Abstract

BackgroundControversy still exists on the effect that obesity has on the morbidity and mortality in severe acute pancreatitis (SAP). The primary purpose of this study was to compare the mortality rate of obese versus nonobese patients admitted to the ICU for SAP. Secondary goals were to assess the potential risk factors for abdominal compartment syndrome (ACS) and to investigate the performance of validated scoring systems to predict ACS and in-hospital mortality.MethodsA retrospective cohort of adults admitted to the ICU for SAP was stratified by their body mass index (BMI) as obese and nonobese. The rates of morbidity, mortality, and ACS were compared by univariate and multivariate regression analyses. Areas under the curve (AUC) were used to evaluate the discriminating performance of severity scores and other selected variables to predict mortality and the risk of ACS.ResultForty-five patients satisfied the inclusion criteria and 24 (53 %) were obese with similar characteristics to nonobese patients. Among all the subjects, 11 (24 %) died and 16 (35 %) developed ACS. In-hospital mortality was significantly lower for obese patients (12.5 vs. 38 %; P = 0.046) even though they seemed to develop ACS more frequently (41 vs. 28 %; P = 0.533). At multivariable analysis, age was the most significant factor associated with in-hospital mortality (odds ratio (OR) = 1.273; 95 % confidence interval (CI) 1.052–1.541; P = 0.013) and APACHE II and Glasgow-Imrie for the development of ACS (OR = 1.143; 95 % CI 1.012–1.292; P = 0.032 and OR = 1.221; 95 % CI 1.000–1.493; P = 0.05) respectively. Good discrimination for in-hospital mortality was observed for patients’ age (AUC = 0.846) and number of comorbidities (AUC = 0.801). ACS was not adequately predicted by any of the clinical severity scores (AUC = 0.548–0.661).ConclusionsPatients’ age was the most significant factor associated with mortality in patients affected by SAP. Higher APACHE II and Glasgow-Imrie scores were associated with the development of ACS, but their discrimination performance was unsatisfactory.

Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015

“…The mortality rate of acute pancreatitis with complication of ACS varies depending on the report , but a systematic review by van Brunschot et al showed a high mortality rate of 47.5% . Also, a large number of complications from organ disorder/failure have been shown.…”

“…The mortality rate of regional pancreatic infection complicated with ACS is reported to be 24.0–66.7% . Acute pancreatitis with excessive fluid infusion, high severity, renal disorders, creatinine levels, complications of respiratory disorders, tachypnea, and fluid collection in multiple areas, as observed by CT, is likely to develop IAH/ACS , and the measurement of IAP over time is necessary.…”

Mortality predictors of patients suffering of acute pancreatitis and development of intraabdominal hypertension

“…Another study that included patients under the age of 30 who were not previously ill showed that sex had no influence on IAP values (14). It was previously shown that increased BMI leads to the increase of IAP (15)(16)(17)(18) and an increase of 1 kg/m 2 in BMI leads to the increase of 0.07 mmHg of IAP (15). The increase of BMI is correlated to the increase of IAP, but it was also shown that it does not depend on sex or race (15).…”

Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

“…Results clearly showed that early decompression (first 4 days) was associated with significantly less deaths, compared with late decompression (after 4 days). Davis et al [ 12 ] reported 25% mortality in surgically decompressed patients with ACS. Mean time from diagnosis to surgical intervention in their study was 3.1 h. It seems that early surgical decompression in patients with ACS during SAP may be associated with less mortality rate.…”