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Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

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Acknowledgments

This study was presented as an oral presentation at the Digestive Disease Week 2015 and published as an abstract in Gastroenterology 2015;148(4):Suppl 1, Page(s) S-113-114.

Authorship Criteria and Contributions

Study conception and design: Amit Raina, Chandraprakash Umapathy, and Dhiraj Yadav.

Data acquisition: Chandraprakash Umapathy, Amit Raina, and Shreyas Saligram.

Data analysis: Chandraprakash Umapathy and Gong Tang.

Data interpretation: All authors.

Drafting of manuscript: Chandraprakash Umapathy, Gong Tang, and Dhiraj Yadav.

Revising the manuscript and providing important intellectual input and final approval of the version to be published: All authors.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Chandraprakash Umapathy

  2. Division of Gastroenterology, Hepatology, and Nutrition, East Carolina University, Greenville, NC, USA

    Amit Raina

  3. Division of Gastroenterology, Hepatology, and Motility, University of Kansas Medical Center, Kansas City, KS, USA

    Shreyas Saligram

  4. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    Gong Tang

  5. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, M-2, C-Wing, Pittsburgh, PA, 15213, USA

    Georgios I. Papachristou, Mordechai Rabinovitz, Jennifer Chennat, David C. Whitcomb, Adam Slivka & Dhiraj Yadav

  6. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA

    Herbert Zeh, Amer H. Zureikat, Melissa E. Hogg & Kenneth K. Lee

  7. Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA

    Melissa I. Saul

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  1. Chandraprakash Umapathy
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  15. Dhiraj Yadav
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Corresponding author

Correspondence to Dhiraj Yadav.

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The study was approved by the Institutional Review Board of the University of Pittsburgh.

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The authors declare that they have no conflict of interest.

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Umapathy, C., Raina, A., Saligram, S. et al. Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience. J Gastrointest Surg 20, 1844–1853 (2016). https://doi.org/10.1007/s11605-016-3264-2

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  • DOI: https://doi.org/10.1007/s11605-016-3264-2

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