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Gastrointestinal Failure Is a Predictor of Poor Outcome in Patients with Acute Pancreatitis

Digestive Diseases and Sciences volume 65, pages 2419–2426 (2020)Cite this article

Abstract

Objective

Although gastrointestinal dysfunction is common in patients with acute pancreatitis, its impact on the outcome of disease has not been adequately studied. The present study was conducted to study the frequency of gastrointestinal failure (GIF) as well as its effect on outcome in patients with acute pancreatitis.

Methods

Patients with acute pancreatitis admitted in our unit were prospectively studied. Gastrointestinal dysfunction and intra-abdominal pressures were measured daily till their resolution, and gastrointestinal failure score was calculated. Baseline parameters including various severity scores were noted. The patients were followed till clinical recovery or death.

Results

Sixty-four patients (mean age 41.52 ± 16.28 years; 45 (70.3%) males) were prospectively studied. Forty-five (70.3%) patients had severe disease, and 18 (28.1%) patients succumbed to illness. GIF was present in 31 (48.4%) patients. The median duration of GIF was 5 (range 1–20) days. The presence of GIF was significantly associated with mortality (p value < 0.05). On multivariate analysis, the presence of GIF [OR 10.6 (95% CI 1.97–57.04)] and duration of ICU stay [OR 1.08 (95% CI 1.015–1.15)] were found to be independent predictors of mortality.

Conclusion

Gastrointestinal failure is an important organ failure in patients with acute pancreatitis and is an independent predictor of mortality. Incorporation of gastrointestinal failure scores in dynamic assessment of patients with acute pancreatitis could help us in better stratifying severity of patients and predicting outcome.

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Abbreviations

GIF:

Gastrointestinal failure

AP:

Acute pancreatitis

IAH:

Intra-abdominal hypertension

ACS:

Abdominal compartment syndrome

ICU:

Intensive care unit

CVSF:

Cardiovascular failure

FI:

Feeding intolerance

CECT:

Contrast-enhanced computed tomography

MCTSI:

Modified CT severity index

CTSI:

CT severity index

SIRS:

Systemic inflammatory response syndrome

BISAP:

Bedside index of severity of acute pancreatitis

APACHE II:

Acute physiology and chronic health evaluation II

SOFA:

Sequential organ failure assessment

PCD:

Percutaneous drainage

AKI:

Acute kidney injury

IAP:

Intra-abdominal pressure

ALI:

Acute lung injury

IAH:

Intra-abdominal hypertension

BMI:

Body mass index

VARD:

Video-assisted retroperitoneal debridement

OR:

Odds ratio

SD:

Standard deviation

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Author information

Affiliations

  1. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India

    Roshan Agarwala, Surinder Singh Rana & Ravi Sharma

  2. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India

    Mandeep Kang & Ujjwal Gorsi

  3. Division of Surgical Gastroenterology, Department of Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India

    Rajesh Gupta

Authors
  1. Roshan Agarwala
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  2. Surinder Singh Rana
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  3. Ravi Sharma
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  4. Mandeep Kang
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  5. Ujjwal Gorsi
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  6. Rajesh Gupta
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Contributions

RA was involved in design, collection and interpretation of data, and drafting of manuscript. SSR performed design, collection and interpretation of data, and critical evaluation of manuscript. RS, MK, UG, and RG were involved in collection and interpretation of data.

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Correspondence to Surinder Singh Rana.

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Cite this article

Agarwala, R., Rana, S.S., Sharma, R. et al. Gastrointestinal Failure Is a Predictor of Poor Outcome in Patients with Acute Pancreatitis. Dig Dis Sci 65, 2419–2426 (2020). https://doi.org/10.1007/s10620-019-05952-5

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  • DOI: https://doi.org/10.1007/s10620-019-05952-5

Keywords

  • Organ failure
  • Acute pancreatitis
  • Alcohol
  • Gallstones
  • Computed tomography