Robert A Moran1,2, Guillermo García-Rayado3, Daniel de la Iglesia-García4, Emma Martínez-Moneo5, Esther Fort-Martorell6, Eugenia Lauret-Braña7, Mar Concepción-Martín8, Fabio Ausania9, Carlos Prieto-Martínez10, Miguel González-de-Cabo11, Noé Quesada-Vázquez12, M Asunción Marcaide-Ruiz-de-Apodaca13, José A Pajares-Díaz14, Francia C Díaz15, José L de-Benito16, Jennifer Hinojosa-Guadix17, Pilar Marqués-García18, Jaume Boadas19, Eduardo Bajador-Andreu20, Oswaldo Moreno21, Federico Argüelles-Arias22, Gregorio Martín-Benítez23, Carla Tafur-Sánchez24, Jesús Leal-Téllez25, Beatriz Romero-Mosquera26, Ruben Hernaez27, Georgios I Papachristou28, Vikesh K Singh1, Enrique de-Madaria12. 1. Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, USA. 2. Division of Gastroenterology, Medical University of South Carolina, Charleston, USA. 3. Department of Gastroenterology, Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain. 4. Department of Gastroenterology, Complejo Hospitalario de Santiago, Santiago, Spain. 5. Department of Gastroenterology, Hospial Universitario Cruces, Barakaldo, Spain. 6. Department of Gastroenterology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain. 7. Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain. 8. Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 9. Department of Surgery, Hospital Xeral, Vigo, Spain. 10. Department of Gastroenterology, Complejo Universitario de Navarra, Pamplona, Spain. 11. Department of Radiology, Hospital Son Llatzer, Palma de Mallorca, Spain. 12. Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain. 13. Department of Gastroenterology, Hospital Universitario Araba, Vitoria-Gasteiz, Spain. 14. Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain. 15. Department of Gastroenterology, Hospital Universitari i Politècnic la Fe, Valencia, Spain. 16. Department of Radiology, Hospital Clínico de Zaragoza, Zaragoza, Spain. 17. Department of Gastroenterology, Hospital Costa del Sol, Marbella, Spain. 18. Department of Gastroenterology, Hospital Arnau de Vilanova, Valencia, Spain. 19. Department of Gastroenterology, Consorci Sanitari Terrassa, Barcelona, Spain. 20. Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain. 21. Department of Gastroenterology, Hospital Clínico, Valencia, Spain. 22. Department of Gastroenterology, Hospital Universitario Vírgen Macarena, Sevilla, Spain. 23. Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain. 24. Department of Gastroenterology, Hospital Clínico Universitario, Valladolid, Spain. 25. Department of Radiology, Hospital Puerta del Mar, Cádiz, Spain. 26. Department of Gastroenterology, Hospital Meixoeiro, Vigo, Spain. 27. Department of Gastroenterology, Baylor College of Medicine, Houston, USA. 28. Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, USA.
Abstract
BACKGROUND: There are few large prospective cohort studies evaluating predictors of outcomes in acute pancreatitis. OBJECTIVES: The purpose of this study was to determine the role of age and co-morbid disease in predicting major outcomes in acute pancreatitis. METHODS: Data points were collected according to a predefined electronic data collection form. Acute pancreatitis and its complications were defined according to the revised Atlanta classification. Univariable and multivariable analyses were conducted using Cox proportional hazard regression and multiple logistic regression. RESULTS: From June 2013-February 2015, 1655 adult patients were recruited from 23 centres across Spain. Co-morbid disease, obesity, open surgical necrosectomy within 30 days, and pancreatic necrosis were independently associated with both 30-day mortality and persistent organ failure (p < 0.05 for all). Age was not associated with persistent organ failure, however the extreme of age (>85 years) was associated with mortality (p < 0.05). Co-morbid disease and obesity were not independently associated with a prolonged length of stay or other markers of morbidity on adjusted analysis (p > 0.05). CONCLUSION: Comorbidity and obesity are important determinates of mortality and persistent organ failure in acute pancreatitis, but in the absence of organ failure they do not appear to independently contribute to morbidity. This has important implications for severity classification and predictive models of severity in acute pancreatitis.
BACKGROUND: There are few large prospective cohort studies evaluating predictors of outcomes in acute pancreatitis. OBJECTIVES: The purpose of this study was to determine the role of age and co-morbid disease in predicting major outcomes in acute pancreatitis. METHODS: Data points were collected according to a predefined electronic data collection form. Acute pancreatitis and its complications were defined according to the revised Atlanta classification. Univariable and multivariable analyses were conducted using Cox proportional hazard regression and multiple logistic regression. RESULTS: From June 2013-February 2015, 1655 adult patients were recruited from 23 centres across Spain. Co-morbid disease, obesity, open surgical necrosectomy within 30 days, and pancreatic necrosis were independently associated with both 30-day mortality and persistent organ failure (p < 0.05 for all). Age was not associated with persistent organ failure, however the extreme of age (>85 years) was associated with mortality (p < 0.05). Co-morbid disease and obesity were not independently associated with a prolonged length of stay or other markers of morbidity on adjusted analysis (p > 0.05). CONCLUSION: Comorbidity and obesity are important determinates of mortality and persistent organ failure in acute pancreatitis, but in the absence of organ failure they do not appear to independently contribute to morbidity. This has important implications for severity classification and predictive models of severity in acute pancreatitis.
Entities:
Keywords:
Acute pancreatitis; comorbidities; comorbidity; morbidity; mortality; organ failure
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