Extra-pancreatic complications, especially hemodialysis predict mortality and length of stay, in ICU patients admitted with acute pancreatitis. (3rd March 2018)

• Record Type: Journal Article
• Authors: Kothari, Darshan; Struyvenberg, Maarten R; Perillo, Michael C; Ezaz, Ghideon; Freedman, Steven D; Sheth, Sunil G
• Is Part Of: Gastroenterology report. Volume 6:Number 3(2018:Aug.)
• Page Start: 202
• Page End: 209
• Publication Date: 2018-03-03
• Subjects: Severe acute pancreatitis -- extra-pancreatic complications -- intensive care unit -- length of stay -- in-hospital mortality -- infections; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1093/gastro/goy005
• Languages: English
• ISSNs: 2052-0034

Abstract

Abstract: Background and aims: Patients in the intensive care unit (ICU) with acute pancreatitis (AP) are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay. We sought to determine the rate of extra-pancreatic complications and its effect on length of stay (LOS) and mortality in ICU patients with AP. Methods: We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP. A total of 287 ICU patients had a discharge diagnosis of AP, of which 163 met inclusion criteria. We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality. Results: There were a total of 158 extra-pancreatic complications (0.97 extra-pancreatic complications per patient). Ninety-five patients had at least one extra-pancreatic complication, whereas 68 patients had no extra-pancreatic complications. Patients with extra-pancreatic complications had a significantly longer LOS (14.7 vs 8.8 days, p < 0.01) when controlling for local pancreatic complications. Patients with non-infectious extra-pancreatic complications had a higher rate of mortality (24.0% vs 16.2%, p = 0.04). Patients requiring dialysis was an independent predictor for LOS and mortality (incidence risk ratio [IRR] 1.73, 95% confidence interval [CI]: 1.263–2.378 and IRR 1.50, 95% CI 1.623–6.843, p < 0.01) on multi-variable analysis. Coronary events were also a predictor for mortality ( p = 0.05). Other extra-pancreatic complications were not significant. Conclusions: Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS. Patients with non-infectious extra-pancreatic complications have a higher mortality rate. After controlling for local pancreatic complications, patients requiring dialysis remained an independent predictor for LOS and mortality.