- Poster presentation
- Open Access
Severe acute pancreatitis in the ICU
© BioMed Central Ltd 2006
- Published: 21 March 2006
- Acute Pancreatitis
- Organ Failure
- Renal Replacement Therapy
- Severe Acute Pancreatitis
- Survivor Group
To study the clinical characteristics and prognostic factors of patients with severe acute pancreatitis (SAP) admitted to a general purpose ICU of a tertiary care teaching hospital.
Case records of consecutive patients with SAP admitted to the ICU from July 2002 to November 2005 were retrospectively reviewed. Collected data included the demography, etiology, co-morbid illnesses, SOFA and APACHE II scores at admission and after 24 hours, necrosis on CT scan, organ failures and their management, infections, nutrition given, specific interventions done and outcome. The patients were distributed into survivor and nonsurvivor groups and the factors determining outcome were analysed.
Statistical analysis was performed with SPSS 13 software; tests used include ANOVA, the t test and the chi-square test.
Thirty-seven patients with SAP were identified; 13 of them survived ('survivor' group) and 24 died ('nonsurvivor' group). Age, sex, co-morbid illnesses and etiology of pancreatitis did not affect the outcome. Patients with weight >70 kg had a poorer outcome. The mean APACHE II scores at admission were 11.2 ± 5.4 and 20.1 ± 6.6, respectively, in the survivor and nonsurvivor groups (P = 0.01) and SOFA scores were 4.6 ± 3.2 and 8.5 ± 4.3, respectively (P = 0.004). The net change in the APACHE II scores in 24 hours was -11 in the survivor group compared with -1 in the nonsurvivor group (P < 0.001). The organ failures were significantly higher in the nonsurvivor group as against the survivor group. Severe pulmonary failure (lung injury score >2.5), renal failure at admission and need for vasopressors/inotropes were present in 15.4% vs 70.8%, 7.7% vs 62.5% and 23% vs 100% in the survivor and nonsurvivor groups, respectively (P = 0.05, <0.001 and 0.001, respectively). The mean number of days patients required vasopressor/inotrope therapy, mechanical ventilation and renal replacement therapy were significantly higher in the nonsurvivor group. Also, the number of transfusions required was higher. Nasogastric feeding was successful for a longer duration in the survivor group.
The CT scan performed in 25 patients showed necrosis present in 24 patients (eight survivors and 16 nonsurvivors) while one nonsurvivor had no necrosis. Necrosis >50% was associated with a poor outcome (present in 1/8 survivors and 15/17 nonsurvivors, P < 0.001). Drainage of necrosis was by percutaneous route or surgically (open); three survivors and 13 nonsurvivors underwent drainage. Five out of 8 survivors (62.5%) and 4/16 nonsurvivors (25%) had sterile necrosis. Gram-negative enteric bacilli were the common organisms encountered.
SAP has a mortality of 64.8% even with ICU management. Body weight >70 kg, high APACHE II score, organ failures, especially pulmonary, cardiovascular and renal, and pancreatic necrosis >50% are independent predictors of mortality. A decrease in the APACHE II score in 24 hours identifies patients with a good prognosis.