Risk factors for mortality in emphysematous pancreatitis

Abstract

Objective: To investigate the difference in the characteristics between patients with emphysematous pancreatitis (EP) who survived and those who died.Methods: PubMed search was performed to gather EP cases from March 1959 to February 2019. Forty-two articles with 58 EP cases were identified and met the study’s inclusion criteria. The elderly were defined as individuals aged >65 years. Data on patients’ demographics, clinical symptoms, laboratory results, treatments, outcomes, and mortality were collected and analyzed by chi-square test and Student’s t-test. p-Value <.05 (2-tailed) was set as the significance level.Results: Forty-seven men and eleven women aged 61.3 ± 15.9 (mean ± standard deviation) years were included. The elderly accounted for 43.1% (n = 25) of cases. There were 20 mortality cases, and 38 cases survived, with an overall mortality rate of 34.5%. Sex, underlying diseases, etiologies, and laboratory results were not significantly related to mortality. Older age was significantly related to mortality (p = .001). The shock was more commonly seen in the mortality group (100%) than in the survival group (21%) (p < .001). In contrast, fever was less frequent in the mortality group than in the survival group (25 vs. 71%, p = .002).Conclusions: EP patients have a high mortality rate (34.5%). Older age, afebrile status, and presence of shock are associated with high mortality. To improve the survival of this aggressive group, a further prospective investigation involving a larger sample size is necessary.

Percutaneous endoscopic necrosectomy in a patient with emphysematous pancreatitis

“…The mortality rate is as high as 34.5%, and older age, afebrile status, and the presence of shock are associated with higher mortality. [8] In the 1980s, open necrosectomies were believed to be the best treatment for necrotizing pancreatitis patients with necrotic tissue. [5] However, the paradigm has shifted to a minimally invasive step-up approach, consisting of conservative treatment, percutaneous and endoscopic drainage, and minimally invasive necrosectomy.…”

Surgical intervention for acute pancreatitis in the COVID-19 era

“…AP may result from bile duct or gallstone-related pancreatitis, a recent history of alcohol abuse or consumption, usage of some medications, hypertriglyceridemia, extracorporeal shock wave lithotripsy, post-endoscopic retrograde cholangiopancreatography (ERCP), genetic causes, trauma that causes pancreatic duct injury, hypercalcemia, and infections; idiopathic factors have also been hypothesized to cause AP[ 1 , 8 , 9 ]. COVID-19-AP has been associated with a significant increment (2.5-fold) in the incidence of idiopathic pancreatitis compared to patients without COVID-19.…”

“…The surgical treatment strategy includes early administration of antibiotics and percutaneous drainage of collected fluid, followed by surgical resection of the infected necrotic tissue[ 8 ]. Gas-forming bacteria may reach the pancreatic bed via the bloodstream, lymphatic channels, fistula of the nearby bowel, translocate from the transverse colon, or reflux via the opening of the ampulla of Vater[ 1 ].…”

“…Reduced cholecystectomy rates inevitably increase waiting lists and are likely, in time, to lead to an increase in the incidence of serious complications[ 7 ]. Patients with COVID-19-related AP were found to have a mortality rate of 12.4%-18.5%[ 37 , 38 ]; these values are higher than the overall mortality rate of 10.7% for emphysematous pancreatitis reported in a Asian study[ 1 ]. Medical treatment had good outcomes in patients with stable emphysematous pancreatitis (35.7%); surgical necrosectomy was performed for the other 64.3% of patients with persistent decompensated organ failure[ 1 ].…”

“…The majority of patients with AP experience an uncomplicated course after palliative management. However, approximately 5%-10% of cases develop necrotizing or hemorrhagic pancreatitis, and patients with progressive organ failure, infectious complications, or who require surgical intervention have higher rates of morbidity and mortality[ 1 ].…”