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Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience
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 du...
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| Published in: | Journal of gastrointestinal surgery 2016-11, Vol.20 (11), p.1844-1853 |
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| container_title | Journal of gastrointestinal surgery |
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| creator | Umapathy, Chandraprakash Raina, Amit Saligram, Shreyas Tang, Gong Papachristou, Georgios I. Rabinovitz, Mordechai Chennat, Jennifer Zeh, Herbert Zureikat, Amer H. Hogg, Melissa E. Lee, Kenneth K. Saul, Melissa I. Whitcomb, David C. Slivka, Adam Yadav, Dhiraj |
| description | 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
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. |
| doi_str_mv | 10.1007/s11605-016-3264-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835675542</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4225801491</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-5647ea8f233e4fb21bb985fef167f74d5b076b83a48f7d94fd1d4b0cbfa79bd93</originalsourceid><addsrcrecordid>eNp1kF1LHDEUhkOpVGv7A7yRQG96M22-k_FuWbQWFhVUaK9CMnOyRHZn1iQDrb_eDGtLEXqVQJ73PTkPQieUfKGE6K-ZUkVkQ6hqOFOiYW_QETWaN0Ix9bbeSUsbJuWPQ_Q-5wdCqCbUvEOHTCvaGmKO0M8rV6bkNvgy5jKm33gRCiS86KYC-Aq6NJb4FIc1vnFDl8CVWGI-ww6vXFoDvr_Fd5BKdDW5dAnw-a8dpAhDBx_QQXCbDB9fzmN0f3F-t7xsVtffvi8Xq6bjmpVGKqHBmcA4BxE8o963RgYIVOmgRS890cob7oQJum9F6GkvPOl8cLr1fcuP0ed97y6NjxPkYrcxd7DZuAHGKVtquFRaSsEq-ukV-jBOaai_m6k6sGV8puieqsvnnCDYXYrbuqGlxM7e7d67rd7t7N3OmdOX5slvof-b-CO6AmwP5Po0rCH9M_q_rc9dx40i</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1831679232</pqid></control><display><type>article</type><title>Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience</title><source>Springer Nature</source><creator>Umapathy, Chandraprakash ; Raina, Amit ; Saligram, Shreyas ; Tang, Gong ; Papachristou, Georgios I. ; Rabinovitz, Mordechai ; Chennat, Jennifer ; Zeh, Herbert ; Zureikat, Amer H. ; Hogg, Melissa E. ; Lee, Kenneth K. ; Saul, Melissa I. ; Whitcomb, David C. ; Slivka, Adam ; Yadav, Dhiraj</creator><creatorcontrib>Umapathy, Chandraprakash ; Raina, Amit ; Saligram, Shreyas ; Tang, Gong ; Papachristou, Georgios I. ; Rabinovitz, Mordechai ; Chennat, Jennifer ; Zeh, Herbert ; Zureikat, Amer H. ; Hogg, Melissa E. ; Lee, Kenneth K. ; Saul, Melissa I. ; Whitcomb, David C. ; Slivka, Adam ; Yadav, Dhiraj</creatorcontrib><description>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.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-016-3264-2</identifier><identifier>PMID: 27619808</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Archives & records ; Endoscopy ; Enzymes ; Female ; Gastroenterology ; Hepatology ; Hospitalization ; Hospitals ; Humans ; Infections ; Intensive care ; Intervention ; Length of stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Natural history ; Necrosis ; Original Article ; Pancreatitis ; Pancreatitis, Acute Necrotizing - complications ; Pancreatitis, Acute Necrotizing - epidemiology ; Pancreatitis, Acute Necrotizing - mortality ; Retrospective Studies ; Surgery ; Survival Analysis ; Tertiary Healthcare - statistics & numerical data ; Treatment Outcome ; United States - epidemiology</subject><ispartof>Journal of gastrointestinal surgery, 2016-11, Vol.20 (11), p.1844-1853</ispartof><rights>The Society for Surgery of the Alimentary Tract 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-5647ea8f233e4fb21bb985fef167f74d5b076b83a48f7d94fd1d4b0cbfa79bd93</citedby><cites>FETCH-LOGICAL-c372t-5647ea8f233e4fb21bb985fef167f74d5b076b83a48f7d94fd1d4b0cbfa79bd93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27619808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Umapathy, Chandraprakash</creatorcontrib><creatorcontrib>Raina, Amit</creatorcontrib><creatorcontrib>Saligram, Shreyas</creatorcontrib><creatorcontrib>Tang, Gong</creatorcontrib><creatorcontrib>Papachristou, Georgios I.</creatorcontrib><creatorcontrib>Rabinovitz, Mordechai</creatorcontrib><creatorcontrib>Chennat, Jennifer</creatorcontrib><creatorcontrib>Zeh, Herbert</creatorcontrib><creatorcontrib>Zureikat, Amer H.</creatorcontrib><creatorcontrib>Hogg, Melissa E.</creatorcontrib><creatorcontrib>Lee, Kenneth K.</creatorcontrib><creatorcontrib>Saul, Melissa I.</creatorcontrib><creatorcontrib>Whitcomb, David C.</creatorcontrib><creatorcontrib>Slivka, Adam</creatorcontrib><creatorcontrib>Yadav, Dhiraj</creatorcontrib><title>Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Archives & records</subject><subject>Endoscopy</subject><subject>Enzymes</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Intensive care</subject><subject>Intervention</subject><subject>Length of stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Natural history</subject><subject>Necrosis</subject><subject>Original Article</subject><subject>Pancreatitis</subject><subject>Pancreatitis, Acute Necrotizing - complications</subject><subject>Pancreatitis, Acute Necrotizing - epidemiology</subject><subject>Pancreatitis, Acute Necrotizing - mortality</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Tertiary Healthcare - statistics & numerical data</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp1kF1LHDEUhkOpVGv7A7yRQG96M22-k_FuWbQWFhVUaK9CMnOyRHZn1iQDrb_eDGtLEXqVQJ73PTkPQieUfKGE6K-ZUkVkQ6hqOFOiYW_QETWaN0Ix9bbeSUsbJuWPQ_Q-5wdCqCbUvEOHTCvaGmKO0M8rV6bkNvgy5jKm33gRCiS86KYC-Aq6NJb4FIc1vnFDl8CVWGI-ww6vXFoDvr_Fd5BKdDW5dAnw-a8dpAhDBx_QQXCbDB9fzmN0f3F-t7xsVtffvi8Xq6bjmpVGKqHBmcA4BxE8o963RgYIVOmgRS890cob7oQJum9F6GkvPOl8cLr1fcuP0ed97y6NjxPkYrcxd7DZuAHGKVtquFRaSsEq-ukV-jBOaai_m6k6sGV8puieqsvnnCDYXYrbuqGlxM7e7d67rd7t7N3OmdOX5slvof-b-CO6AmwP5Po0rCH9M_q_rc9dx40i</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Umapathy, Chandraprakash</creator><creator>Raina, Amit</creator><creator>Saligram, Shreyas</creator><creator>Tang, Gong</creator><creator>Papachristou, Georgios I.</creator><creator>Rabinovitz, Mordechai</creator><creator>Chennat, Jennifer</creator><creator>Zeh, Herbert</creator><creator>Zureikat, Amer H.</creator><creator>Hogg, Melissa E.</creator><creator>Lee, Kenneth K.</creator><creator>Saul, Melissa I.</creator><creator>Whitcomb, David C.</creator><creator>Slivka, Adam</creator><creator>Yadav, Dhiraj</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience</title><author>Umapathy, Chandraprakash ; Raina, Amit ; Saligram, Shreyas ; Tang, Gong ; Papachristou, Georgios I. ; Rabinovitz, Mordechai ; Chennat, Jennifer ; Zeh, Herbert ; Zureikat, Amer H. ; Hogg, Melissa E. ; Lee, Kenneth K. ; Saul, Melissa I. ; Whitcomb, David C. ; Slivka, Adam ; Yadav, Dhiraj</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-5647ea8f233e4fb21bb985fef167f74d5b076b83a48f7d94fd1d4b0cbfa79bd93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Archives & records</topic><topic>Endoscopy</topic><topic>Enzymes</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Intensive care</topic><topic>Intervention</topic><topic>Length of stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Natural history</topic><topic>Necrosis</topic><topic>Original Article</topic><topic>Pancreatitis</topic><topic>Pancreatitis, Acute Necrotizing - complications</topic><topic>Pancreatitis, Acute Necrotizing - epidemiology</topic><topic>Pancreatitis, Acute Necrotizing - mortality</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Tertiary Healthcare - statistics & numerical data</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Umapathy, Chandraprakash</creatorcontrib><creatorcontrib>Raina, Amit</creatorcontrib><creatorcontrib>Saligram, Shreyas</creatorcontrib><creatorcontrib>Tang, Gong</creatorcontrib><creatorcontrib>Papachristou, Georgios I.</creatorcontrib><creatorcontrib>Rabinovitz, Mordechai</creatorcontrib><creatorcontrib>Chennat, Jennifer</creatorcontrib><creatorcontrib>Zeh, Herbert</creatorcontrib><creatorcontrib>Zureikat, Amer H.</creatorcontrib><creatorcontrib>Hogg, Melissa E.</creatorcontrib><creatorcontrib>Lee, Kenneth K.</creatorcontrib><creatorcontrib>Saul, Melissa I.</creatorcontrib><creatorcontrib>Whitcomb, David C.</creatorcontrib><creatorcontrib>Slivka, Adam</creatorcontrib><creatorcontrib>Yadav, Dhiraj</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Databases</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Umapathy, Chandraprakash</au><au>Raina, Amit</au><au>Saligram, Shreyas</au><au>Tang, Gong</au><au>Papachristou, Georgios I.</au><au>Rabinovitz, Mordechai</au><au>Chennat, Jennifer</au><au>Zeh, Herbert</au><au>Zureikat, Amer H.</au><au>Hogg, Melissa E.</au><au>Lee, Kenneth K.</au><au>Saul, Melissa I.</au><au>Whitcomb, David C.</au><au>Slivka, Adam</au><au>Yadav, Dhiraj</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>20</volume><issue>11</issue><spage>1844</spage><epage>1853</epage><pages>1844-1853</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27619808</pmid><doi>10.1007/s11605-016-3264-2</doi><tpages>10</tpages></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2016-11, Vol.20 (11), p.1844-1853 |
| issn | 1091-255X 1873-4626 |
| language | eng |
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| source | Springer Nature |
| subjects | Adult Aged Archives & records Endoscopy Enzymes Female Gastroenterology Hepatology Hospitalization Hospitals Humans Infections Intensive care Intervention Length of stay Male Medicine Medicine & Public Health Middle Aged Mortality Natural history Necrosis Original Article Pancreatitis Pancreatitis, Acute Necrotizing - complications Pancreatitis, Acute Necrotizing - epidemiology Pancreatitis, Acute Necrotizing - mortality Retrospective Studies Surgery Survival Analysis Tertiary Healthcare - statistics & numerical data Treatment Outcome United States - epidemiology |
| title | Natural History After Acute Necrotizing Pancreatitis: a Large US Tertiary Care Experience |
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