Severe pancreatitis. Determinants of mortality in a tertiary referral center
J. T. Malcynski, I. C. Iwanow and K. W. Burchard
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
OBJECTIVE: To determine factors associated with mortality in patients with
severe pancreatitis. DESIGN: Retrospective review. SETTING: University
tertiary referral center intensive care unit (ICU). PATIENTS: Thirty
patients admitted to the ICU with the primary diagnosis of pancreatitis
from 1986 to 1995. MAIN OUTCOME MEASURE: Survival vs nonsurvival. RESULTS:
Twenty-seven patients were transferred from another institution. At the
time of ICU admission, subsequent death was not associated with the
following: systolic blood pressure, pulse rate, hemoglobin level, leukocyte
count, platelet count, or serum calcium concentration. The patients who
died during the study were older at admission (age [mean+/-SD] of those who
lived, 47+/-17 years; age of those who died, 64+/-8 years; P=.01) and their
serum creatinine concentrations were higher (creatinine concentrations
[mean +/-SD] of those who lived, 150+/-90 micromol/L [1.7+/-1.0 mg/dL];
creatinine concentrations of those who died, 410+/-250 micromol/L
[4.6+/-2.8 mg/dL]; P=.001). Clinical events not associated with mortality
included respiratory failure, insulin use, positive blood cultures,
positive pancreatic cultures, and abdominal surgery for pancreatitis and
infected pancreatic necrosis. Death was associated with the use of
inotropic and/or vasopressor support (P=.05) and renal failure (creatinine,
>170 micromol/L[>2.0 mg/dL]) at any time during the ICU stay (P=.01).
Patients with renal failure were no older than the patients without, but
were admitted later after the onset of pancreatitis (mean+/-SD, 5.9+/-7.2
days vs 1.5+/-1.1 days; P=.03; median, 2 days vs 1 days). CONCLUSIONS:
After hospital transfer to a teritiary referral center, only older age, use
of inotropic and/or vasopressor support, and evidence of renal malfunction
are associated with death. Prompt recognition of severe pancreatitis,
especially in older patients, aggressive hemodynamic management, and/or
earlier transfer to a tertiary care center may diminish the incidence of
renal failure and mortality in severe pancreatitis.
