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Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia
Objective To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. Methods A retrospective single‐...
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| Published in: | Emergency medicine Australasia 2017-04, Vol.29 (2), p.184-191 |
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| container_title | Emergency medicine Australasia |
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| creator | Sundararajan, Krishnaswamy Schoeman, Tom Hughes, Lara Edwards, Suzanne Reddi, Benjamin |
| description | Objective
To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia.
Methods
A retrospective single‐centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2.
Results
Eighty‐seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients’ age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P |
| doi_str_mv | 10.1111/1742-6723.12737 |
| format | article |
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To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia.
Methods
A retrospective single‐centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2.
Results
Eighty‐seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients’ age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non‐survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED.
Conclusion
Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non‐inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high‐risk of death.</description><identifier>ISSN: 1742-6731</identifier><identifier>EISSN: 1742-6723</identifier><identifier>DOI: 10.1111/1742-6723.12737</identifier><identifier>PMID: 28125855</identifier><language>eng</language><publisher>Melbourne: Wiley Publishing Asia Pty Ltd</publisher><subject>Adult ; Aged ; Alcoholism - complications ; APACHE II score ; Australia - epidemiology ; BISAP score ; Critical Illness - epidemiology ; Critical Illness - mortality ; emergency department ; Emergency Service, Hospital - organization & administration ; Emergency Service, Hospital - statistics & numerical data ; Female ; Gallstones - complications ; Humans ; Injury Severity Score ; intensive care unit ; Logistic Models ; Male ; Middle Aged ; Pancreatitis - etiology ; Pancreatitis - mortality ; Patient Outcome Assessment ; Prognosis ; Retrospective Studies ; severe acute pancreatitis ; Tertiary Care Centers - organization & administration ; Tertiary Care Centers - statistics & numerical data</subject><ispartof>Emergency medicine Australasia, 2017-04, Vol.29 (2), p.184-191</ispartof><rights>2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine</rights><rights>2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3437-2491b18e216cedbfbf6976cf4c09008d05169bc56e09167af130aea6703ba3803</citedby><cites>FETCH-LOGICAL-c3437-2491b18e216cedbfbf6976cf4c09008d05169bc56e09167af130aea6703ba3803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28125855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sundararajan, Krishnaswamy</creatorcontrib><creatorcontrib>Schoeman, Tom</creatorcontrib><creatorcontrib>Hughes, Lara</creatorcontrib><creatorcontrib>Edwards, Suzanne</creatorcontrib><creatorcontrib>Reddi, Benjamin</creatorcontrib><title>Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia</title><title>Emergency medicine Australasia</title><addtitle>Emerg Med Australas</addtitle><description>Objective
To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia.
Methods
A retrospective single‐centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2.
Results
Eighty‐seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients’ age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non‐survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED.
Conclusion
Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non‐inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high‐risk of death.</description><subject>Adult</subject><subject>Aged</subject><subject>Alcoholism - complications</subject><subject>APACHE II score</subject><subject>Australia - epidemiology</subject><subject>BISAP score</subject><subject>Critical Illness - epidemiology</subject><subject>Critical Illness - mortality</subject><subject>emergency department</subject><subject>Emergency Service, Hospital - organization & administration</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Gallstones - complications</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>intensive care unit</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatitis - etiology</subject><subject>Pancreatitis - mortality</subject><subject>Patient Outcome Assessment</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>severe acute pancreatitis</subject><subject>Tertiary Care Centers - organization & administration</subject><subject>Tertiary Care Centers - statistics & numerical data</subject><issn>1742-6731</issn><issn>1742-6723</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqFkUtPAyEUhYnRaK2u3RmWbtrCMDMwy6apj8RGF7omDHOnYpiHwMT0r_hrpQ-7lQ039xy-XO5B6IaSKY1nRnmaTHKesClNOOMnaHTsnB5rRi_QpfefhCQipcU5ukgETTKRZSP08-qgMjp0zmPVVrgbgu4a8LirsdJDANyrVjtQwQTjsWmxdrHSytoNNtZGORhog8e9Ax8L065x6HD4AAwNuDW0eoMr6JULTZR3XBzABaPcBjuowTllsY6agy1_PvgQO0ZdobNaWQ_Xh3uM3u-Xb4vHyfPLw9Ni_jzRLGV8kqQFLamAhOYaqrIu67zgua5TTQpCREUymhelznIgBc25qikjClTOCSsVE4SN0d2e27vuawAfZGO8BmtVC93gJRWcCFaItIjW2d6qXed9HF72zjTxI5ISuQ1Eblcut-uXu0Dii9sDfCgbqI7-vwSiIdsbvo2FzX88uVyt9uBfjzCYfQ</recordid><startdate>201704</startdate><enddate>201704</enddate><creator>Sundararajan, Krishnaswamy</creator><creator>Schoeman, Tom</creator><creator>Hughes, Lara</creator><creator>Edwards, Suzanne</creator><creator>Reddi, Benjamin</creator><general>Wiley Publishing Asia Pty Ltd</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>7X8</scope></search><sort><creationdate>201704</creationdate><title>Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia</title><author>Sundararajan, Krishnaswamy ; Schoeman, Tom ; Hughes, Lara ; Edwards, Suzanne ; Reddi, Benjamin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3437-2491b18e216cedbfbf6976cf4c09008d05169bc56e09167af130aea6703ba3803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Alcoholism - complications</topic><topic>APACHE II score</topic><topic>Australia - epidemiology</topic><topic>BISAP score</topic><topic>Critical Illness - epidemiology</topic><topic>Critical Illness - mortality</topic><topic>emergency department</topic><topic>Emergency Service, Hospital - organization & administration</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Gallstones - complications</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>intensive care unit</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreatitis - etiology</topic><topic>Pancreatitis - mortality</topic><topic>Patient Outcome Assessment</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>severe acute pancreatitis</topic><topic>Tertiary Care Centers - organization & administration</topic><topic>Tertiary Care Centers - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sundararajan, Krishnaswamy</creatorcontrib><creatorcontrib>Schoeman, Tom</creatorcontrib><creatorcontrib>Hughes, Lara</creatorcontrib><creatorcontrib>Edwards, Suzanne</creatorcontrib><creatorcontrib>Reddi, Benjamin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Emergency medicine Australasia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sundararajan, Krishnaswamy</au><au>Schoeman, Tom</au><au>Hughes, Lara</au><au>Edwards, Suzanne</au><au>Reddi, Benjamin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia</atitle><jtitle>Emergency medicine Australasia</jtitle><addtitle>Emerg Med Australas</addtitle><date>2017-04</date><risdate>2017</risdate><volume>29</volume><issue>2</issue><spage>184</spage><epage>191</epage><pages>184-191</pages><issn>1742-6731</issn><eissn>1742-6723</eissn><abstract>Objective
To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia.
Methods
A retrospective single‐centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2.
Results
Eighty‐seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients’ age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non‐survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED.
Conclusion
Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non‐inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high‐risk of death.</abstract><cop>Melbourne</cop><pub>Wiley Publishing Asia Pty Ltd</pub><pmid>28125855</pmid><doi>10.1111/1742-6723.12737</doi><tpages>1</tpages></addata></record> |
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| ispartof | Emergency medicine Australasia, 2017-04, Vol.29 (2), p.184-191 |
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| subjects | Adult Aged Alcoholism - complications APACHE II score Australia - epidemiology BISAP score Critical Illness - epidemiology Critical Illness - mortality emergency department Emergency Service, Hospital - organization & administration Emergency Service, Hospital - statistics & numerical data Female Gallstones - complications Humans Injury Severity Score intensive care unit Logistic Models Male Middle Aged Pancreatitis - etiology Pancreatitis - mortality Patient Outcome Assessment Prognosis Retrospective Studies severe acute pancreatitis Tertiary Care Centers - organization & administration Tertiary Care Centers - statistics & numerical data |
| title | Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia |
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