Factors Influencing Mortality in Acute Pancreatitis

Abstract

Severe acture pancreatitis (SAP), a multisystem disease, is characterized by multiple organ system failure and additionally by local pancreatic complications such as necrosis, abscess, or pseudocyst. The rate of mortality in SAP, which is about 20% of all cases of acute pancreatitis (AP), may be as high as 25%, as in infected pancreatic necrosis. The factors that influence mortality in different degrees are various. Etiology for the episode, age, sex, race, ethnicity, genetic makeup, severity on admission, and the extent and nature of pancreatic necrosis (sterile vs. infected) influence the mortality. Other factors include treatment modalities such as administration of prophylactic antibiotics, the mode of feeding (TPN vs. enteral), ERCP with sphincterotomy, and surgery in selected cases. Epidemiological studies indicate that the incidence of AP is increasing along with an increase in obesity, a bad prognostic factor. Many studies have indicated a worse prognosis in idiopathic AP compared to pancreatitis induced by alcoholism or biliary stone. The risk for SAP after ERCP is the subject of extensive study. AP after trauma, organ transplant, or coronary artery bypass surgery is rare but may be serious. Since Ranson reported early prognostic criteria, a number of attempts have been made to simplify or add new clinical or laboratory studies in the early assessment of severity. Obesity, hemoconcentration on admission, presence of pleural effusion, increased fasting blood sugar, as well as creatinine, elevated CRP in serum, and urinary trypsinogen levels are some of the well-documented factors in the literature. The role of appropriate prophylactic antibiotic therapy although still is highly controversial, in properly chosen cases appears to be beneficial and well accepted in clinical practice. Early enteral nutrition has gained much support and jejunal feeding bypassing the pancreatic stimulatory effect of it in the duodenum is desirable in selected cases. The limited role for endoscopic sphincterotomy in patients with demonstrated dilated CBD with impacted stone and evidence of impending cholangitis is well documented. Surgery in AP other than for removal of the gallbladder is often limited to infected pancreatic necrosis, pseudocysts, and pancreatic abscess and in some cases of traumatic pancreatitis with a ruptured duct system. The progress in the understanding of the role of cytokines will over us opportunities to use immunomodulatory therapies to improve the outcome in SAP.

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

“…We also observed significant improvement in Marshall score and MODS of patients with resolution of IAH. The overall mortality rate in our study of approximately 23% is comparable to the 10%-50% reported in AP patients by others [18][19][20][21] . The mortality in ACS patients in our study (75%), however, was much higher than that in patients without ACS which is not acceptable for us, although post-injury ACS has been consistently reported to have a high mortality ranging from 25%-75%.…”

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

“…(14) There are many causes but the most important so far are considered to be gallstones and alcohol. (15)(16)(17)(18) It has been claimed that gallstone of small size up to 5mm can enter the cystic duct and can produce this lethal syndrome. (19) There is a global consensus that female are the common victims as they harbor gallstones more frequently than males and males are more frequent victims because of alcohol.…”

Evaluation of CT severity index, Ranson and APACHE II and Ranson scores for clinical course and mortality in mechanically ventilated patients depend to severe pancreatitis

“…In elderly patients, the biliary and idiopathic pancreatitis are reported as 64.9% and 26.6% respectively (22). Many studies have indicated a worse prognosis in idiopathic AP compared to pancreatitis induced by alcoholism or gallstone (23).…”