Chandraprakash Umapathy1, Amit Raina2, Shreyas Saligram3, Gong Tang4, Georgios I Papachristou5, Mordechai Rabinovitz5, Jennifer Chennat5, Herbert Zeh6, Amer H Zureikat6, Melissa E Hogg6, Kenneth K Lee6, Melissa I Saul7, David C Whitcomb5, Adam Slivka5, Dhiraj Yadav8. 1. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 2. Division of Gastroenterology, Hepatology, and Nutrition, East Carolina University, Greenville, NC, USA. 3. Division of Gastroenterology, Hepatology, and Motility, University of Kansas Medical Center, Kansas City, KS, USA. 4. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA. 5. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA. 6. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA. 7. Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA. 8. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA. yadavd@upmc.edu.
Abstract
BACKGROUND: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. METHODS: Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted. RESULTS: Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p < 0.001). Increasing age (HR 1.05), persistent organ failure (HR 4.5), and >50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively. CONCLUSION: ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
BACKGROUND: Most studies of acute necrotizing pancreatitis (ANP) focus on short-term outcomes. We evaluated long-term survival and outcomes following ANP. METHODS:Patients treated for ANP at the University of Pittsburgh Medical Center from 2001 to 2008 were studied. Data on presentation and course during initial hospitalization and follow-up (median 34 months) was extracted. RESULTS: Mean age of patients (n = 167) was 53 ± 16 years; 70 % were male, 94 % white, 71 % transfers, 52 % biliary etiology, and 78 % had first-attack of acute pancreatitis. Majority had severe disease with high Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (median 11), length of stay (median 26 days), intensive care unit (ICU) admission (87 %), presence of systemic inflammatory response syndrome (SIRS) (90 %), persistent organ failure (60 %), and infected necrosis (50 %). Intervention was needed in 74 %. Eighteen (10.8 %) patients died during index hospitalization, 9 (5.4 %) during the first year, and 13 (7.8 %) after 1 year. Median survival was significantly shorter when compared with age- and sex-matched US general population (9.1 vs. 26.1 years, p < 0.001). Increasing age (HR 1.05), persistent organ failure (HR 4.5), and >50 % necrosis (HR 3.8) were independent predictors of death at 1 year. In eligible patients, new-onset diabetes, oral pancreatic enzyme replacement therapy, and disability were noted in 45, 25, and 53 %, respectively. CONCLUSION: ANP significantly impacts long-term survival. A high proportion of patients develop functional derangement and disability following ANP.
Authors: B W M Spanier; Y Nio; R W M van der Hulst; H A R E Tuynman; M G W Dijkgraaf; M J Bruno Journal: Pancreatology Date: 2010-05-17 Impact factor: 3.996
Authors: Enrique de-Madaria; Gema Soler-Sala; José Sánchez-Payá; Inmaculada Lopez-Font; Juan Martínez; Laura Gómez-Escolar; Laura Sempere; Cristina Sánchez-Fortún; Miguel Pérez-Mateo Journal: Am J Gastroenterol Date: 2011-08-30 Impact factor: 10.864
Authors: Hjalmar C van Santvoort; Marc G Besselink; Olaf J Bakker; H Sijbrand Hofker; Marja A Boermeester; Cornelis H Dejong; Harry van Goor; Alexander F Schaapherder; Casper H van Eijck; Thomas L Bollen; Bert van Ramshorst; Vincent B Nieuwenhuijs; Robin Timmer; Johan S Laméris; Philip M Kruyt; Eric R Manusama; Erwin van der Harst; George P van der Schelling; Tom Karsten; Eric J Hesselink; Cornelis J van Laarhoven; Camiel Rosman; Koop Bosscha; Ralph J de Wit; Alexander P Houdijk; Maarten S van Leeuwen; Erik Buskens; Hein G Gooszen Journal: N Engl J Med Date: 2010-04-22 Impact factor: 91.245
Authors: Paul Georg Lankisch; Nils Breuer; Anja Bruns; Bettina Weber-Dany; Albert B Lowenfels; Patrick Maisonneuve Journal: Am J Gastroenterol Date: 2009-07-14 Impact factor: 10.864
Authors: Timothy B Gardner; Prabhleen Chahal; Georgios I Papachristou; Santhi Swaroop Vege; Bret T Petersen; Christopher J Gostout; Mark D Topazian; Naoki Takahashi; Michael G Sarr; Todd H Baron Journal: Gastrointest Endosc Date: 2009-02-24 Impact factor: 9.427
Authors: Martin L Freeman; Jens Werner; Hjalmar C van Santvoort; Todd H Baron; Marc G Besselink; John A Windsor; Karen D Horvath; Eric vanSonnenberg; Thomas L Bollen; Santhi Swaroop Vege Journal: Pancreas Date: 2012-11 Impact factor: 3.327
Authors: Amir Gougol; Jorge D Machicado; Bassem Matta; Pedram Paragomi; Ioannis Pothoulakis; Adam Slivka; David C Whitcomb; Dhiraj Yadav; Georgios I Papachristou Journal: Pancreas Date: 2019 Nov/Dec Impact factor: 3.327
Authors: Nicole L Komara; Pedram Paragomi; Phil J Greer; Anette S Wilson; Cameron Breze; Georgios I Papachristou; David C Whitcomb Journal: Am J Physiol Gastrointest Liver Physiol Date: 2020-09-02 Impact factor: 4.052
Authors: Thomas K Maatman; Alexandra M Roch; Eugene P Ceppa; Jeffrey J Easler; Mark A Gromski; Michael G House; Attila Nakeeb; C Max Schmidt; Stuart Sherman; Nicholas J Zyromski Journal: Surgery Date: 2020-08-22 Impact factor: 3.982
Authors: Wei Huang; Daniel de la Iglesia-García; Iria Baston-Rey; Cristina Calviño-Suarez; Jose Lariño-Noia; Julio Iglesias-Garcia; Na Shi; Xiaoying Zhang; Wenhao Cai; Lihui Deng; Danielle Moore; Vikesh K Singh; Qing Xia; John A Windsor; J Enrique Domínguez-Muñoz; Robert Sutton Journal: Dig Dis Sci Date: 2019-06-04 Impact factor: 3.487
Authors: Santiago Cegarra Garcia; Michael Toolis; Max Ubels; Taha Mollah; Eldho Paul; Ashish Pandey; Brandon Thia; Tricia Wong; Ravindranath Tiruvoipati Journal: SAGE Open Med Date: 2021-07-10