Dataset Information

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.

ABSTRACT:

Background

Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF.

Objective

We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.

Methods

We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders.

Results

58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality.

Conclusion

In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.

SUBMITTER: Machicado JD

PROVIDER: S-EPMC8259236 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Publications

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.

Machicado Jorge D JD Gougol Amir A Tan Xiaoqing X Gao Xiaotian X Paragomi Pedram P Pothoulakis Ioannis I Talukdar Rupjyoti R Kochhar Rakesh R Goenka Mahesh K MK Gulla Aiste A Gonzalez Jose A JA Singh Vikesh K VK Ferreira Miguel M Stevens Tyler T Barbu Sorin T ST Nawaz Haq H Gutierrez Silvia C SC Zarnescu Narcis O NO Capurso Gabriele G Easler Jeffrey J JJ Triantafyllou Konstantinos K Pelaez-Luna Mario M Thakkar Shyam S Ocampo Carlos C de-Madaria Enrique E Cote Gregory A GA Wu Bechien U BU Conwell Darwin L DL Hart Phil A PA Tang Gong G Papachristou Georgios I GI

United European gastroenterology journal 20210301 2

<h4>Background</h4>Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF.<h4>Objective</h4>We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.<h4>Methods</h4>We studied 1544 AP subjects ...[more]

PMID: 33871926

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Project description:Neutrophil to lymphocyte ratio (NLR) has frequently been reported as a significant indicator of systemic inflammation in various medical conditions. The association underlying NLR and outcomes in patients with acute pancreatitis (AP) has not been evaluated after the publication of revised Atlanta classification.This was a single-center retrospective diagnostic accuracy study and a cohort outcome study. From 2009 to 2015, Asian Chinese patients with a diagnosis of AP presented within 72 hours from symptom onset and underwent neutrophil, lymphocyte assessment at presentation were included in this study. The outcomes were the occurrence of persistent organ failure (POF), intensive care unit (ICU) stay >7 days, and in-hospital mortality. The relationships of baseline neutrophil, lymphocyte count, and NLR with outcomes were assessed with multivariate Cox regression model.A total of 974 consecutive AP patients were clinically eligible. The mean neutrophils, lymphocytes, and NLR for the entire population were 10.23 ± 4.76 × 10/L, 1.05 ± 0.49 × 10/L, and 12.88 ± 11.25. Overall, 223 (22.9%) of the patients developed with POF, 202 (20.7%) spent more than 7 days in ICU, and 58 (6.0%) died during hospitalization. The NLR had a superior predictive performance than neutrophils and lymphocytes. Using an NLR cutoff of 11, the area under the curves (AUC) were 0.76 for POF, 0.74 for longer ICU stay, and 0.79 for death during hospitalization. After multivariate analysis, NLR ≥ 11 was further identified as an independent prognostic factor (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.00-1.89; HR 1.44, 95% CI 1.03-2.00; HR 2.75, 95% CI 1.12-6.76; all P value < 0.05). Following stratification according to quartiles of NLR, positive trends for the association across increasing NLR quartiles and the 3 outcomes were observed (P values for trends across quartiles were 0.007, 0.016, and 0.028, respectively). The adjusted HRs for highest NLR quartile versus the lowest were 2.80 (95% CI 1.42-5.51) (POF), 2.79 (95% CI 1.37-5.70) (ICU > 7 days), and 2.22 (95% CI 0.49-10.05) (mortality), respectively.Our data show for the first time that an increased NLR is an independent risk factor for POF, longer ICU stay, and in-hospital mortality in AP.

Dataset Information

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.

Background

Objective

Methods

Results

Conclusion

Publications

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.

Similar Datasets

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