United European gastroenterology journal · 2021
Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Machicado Jorge D, Gougol Amir, Tan Xiaoqing, Gao Xiaotian, Paragomi Pedram, Pothoulakis Ioannis, Talukdar Rupjyoti, Kochhar Rakesh, Goenka Mahesh K, Gulla Aiste, Gonzalez Jose A, Singh Vikesh K, Ferreira Miguel, Stevens Tyler, Barbu Sorin T, Nawaz Haq, Gutierrez Silvia C, Zarnescu Narcis O, Capurso Gabriele, Easler Jeffrey J, Triantafyllou Konstantinos, Pelaez-Luna Mario, Thakkar Shyam, Ocampo Carlos, de-Madaria Enrique, Cote Gregory A, Wu Bechien U, Conwell Darwin L, Hart Phil A, Tang Gong, Papachristou Georgios I
Аннотация
BACKGROUND: Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF.
OBJECTIVE: We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.
METHODS: We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders.
RESULTS: 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality.
CONCLUSION: In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.
OBJECTIVE: We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.
METHODS: We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders.
RESULTS: 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality.
CONCLUSION: In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.