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

Kothari, Darshan; Struyvenberg, Maarten R.; Perillo, Michael; Ezaz, Ghideon; Freedman, Steven D.; Sheth, Sunil G.

doi:10.1093/gastro/goy005

Cited by 8 publications

(14 citation statements)

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“…The mortality rate in our cohort was similar to that previously reported [6, 8, 9, 23]. Patients who received delayed AIT had poorer outcomes in terms of morbidity, nosocomial infections and length of ICU stay, despite a less severe clinical status on admission.…”

Section: Discussionsupporting

confidence: 87%

“…In another large cohort of 173 infected patients with AP, Besselink et al reported 98 (57%) cases of infected necrosis and 84 (49%) cases of pneumonia, but these rates were reported for the entire stay [23]. In another retrospective study focusing on extrapancreatic complications in ICU patients with AP, infectious complications were observed in 56/103 (54%) patients with a predominance of respiratory and urinary tract infections (43% and 21.5% of all infectious complications, respectively) [6].…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

et al. 2019

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BackgroundRecent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP.MethodsUsing a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model.ResultsIn this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057).ConclusionsHigh proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

et al. 2019

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“…Our study follows our previous report on all EPCs in patients admitted to the ICU with AP 13 . Furthermore, it corroborates the results of previous studies demonstrating the impact of infectious EPCs, which reported bacteremia, UTIs, and respiratory infections being the most common infections 12,16–18 .…”

Section: Discussionsupporting

confidence: 92%

“…Not surprisingly, GI bleeding was an independent predictor of LOS as seen in previous studies. 13 In our study, we demonstrate that 1 in 5 patients with mild AP will have an EPC, which contributes to the LOS. Patients with mild AP typically have minimal symptoms and, in many cases, can improve within 24 hours.…”

Section: Discussionmentioning

confidence: 48%

Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes

Shah¹,

Yakah²,

Ahmed³

et al. 2022

Pancreas

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ObjectivePatients with acute pancreatitis (AP) are at risk for extrapancreatic complications (EPCs) when admitted to the intensive care unit (ICU). We assessed the prevalence of EPCs in non-ICU AP patients and their outcomes.MethodsWe retrospectively studied EPCs in non-ICU AP patients between 2008 and 2018. Outcomes such as length of stay (LOS), inpatient mortality, and 30-day readmission rates were compared between those with and without EPC.ResultsOf the 830 AP patients, 151 (18.1%) had at least 1 EPC. These included urinary tract infection (15.9%), Clostridium difficile infection (17.2%), pneumonia (7.3%), bacteremia (17.2%), acute kidney injury requiring dialysis (3.3%), gastrointestinal bleeding (12.5%), alcohol withdrawal (24.5%), delirium (14.5%), and falls (1.32%). Patients with EPC had increased mean LOS (6.98 vs 4.42 days; P < 0.001) and 30-day readmissions (32.5% vs 19%; P < 0.001). On multivariate regression, EPCs were independently associated with higher LOS (odds ratio, 1.45 [95% confidence interval, 1.36–1.56]; P < 0.001) and 30-day readmissions (odds ratio, 1.94 [95% confidence interval 1.28–2.95]; P < 0.001).ConclusionsThe EPCs are common among noncritical AP patients and contribute to poor outcomes like increased LOS and 30-day readmissions.

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“…However, LNR was not incorporated into our prediction model due to the different tumor type, the larger cohort in our study, and different statistical approach. Notably, more than 6 h of operating time, more than 1 month stay in hospital, and more severe complications (Clavien-Dindo Grade >1) tend to indicate complicated surgery [43][44][45][46], and the complexity of surgery is often positively associated with tumor malignancy. Most malignant tumors can invade the important organs and blood vessels nearby, which greatly increases the difficulty of surgery and worsens the prognosis.…”

Section: E918882-8mentioning

confidence: 99%

A Nomogram for Individual Prediction of Poor Prognosis After Radical Surgery in Patients with Primary Pancreatic Duct Adenocarcinoma

et al. 2020

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Background: Pancreatic cancer is a highly malignant tumor characterized by poor prognosis. TNM stage cannot always provide accurate prediction of prognosis, which is vital for individualized treatment. Therefore, a novel way to identify patients with poor prognosis after radical surgery is urgently needed. Material/Methods: The nomogram was established based on a discovery cohort that included 554 patients with PDAC who had received radical surgery from 2012 to 2016. The clinicopathological data were collected. Poor prognosis was evaluated using 25 features, in which appropriate features for a prediction model were identified. A prediction model incorporating the selected features was established. The discriminative capacity was assessed by C-index, calibration by calibration plot, and clinical usefulness by decision curve. The bootstrapping approach was used to perform internal validation. Results: Characteristics included in the nomogram were coronary artery disease and stroke history, elevated CA125, AJCC stage >II, R0 resection, operating time >6 h, poor differentiation, nerve invasion, length of stay >30 days, and postoperative complications. A C-index of 0.713 indicated good discrimination of the prediction model, and the calibration curve showed acceptable calibration. Survival analysis showed that this model had better discriminative capacity than the AJCC staging system and could distinguish relatively good prognosis from poor prognosis in patients at stage II (especially IIa) and IV. Conclusions: Our study presents a valid and practical model to predict prognosis of pancreatic cancer patients, which contributes to individualized therapy by assisting surgeons to predict poor prognosis in patients who received radical surgery.

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

Cited by 8 publications

References 40 publications

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

Extrapancreatic Complications in Hospitalized Patients With Mild Acute Pancreatitis Are Associated With Poorer Outcomes

A Nomogram for Individual Prediction of Poor Prognosis After Radical Surgery in Patients with Primary Pancreatic Duct Adenocarcinoma

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