Mortality and deterioration factors of acute pancreatitis-The multicenter analysis of death from acute pancreatitis-

DOI Web Site 6 Citations 25 References
  • OTSUKI Makoto
    Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine
  • ITO Tetsuhide
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • KOIZUMI Masaru
    Ohhara Medical Center Hospital
  • SHIMOSEGAWA Tooru
    Division of Gastroenterology, Tohoku University Graduate School of Medicine

Bibliographic Information

Other Title
  • 急性すい炎の致命率と重症化要因―急性すい炎臨床調査の解析―
  • —The multicenter analysis of death from acute pancreatitis—
  • ―急性膵炎臨床調査の解析―

Description

Acute pancreatitis (AP) is a common abdominal disorder with severity varying from mild to fatal disease. The aim of this study was to analyze a large consecutive series of patients with AP and to identify prognostic factors for hospital mortality. Between January 1995 and December 1998, a consecutive series of 1,131 attacks of AP in 1,088, patients were included in the study. We reexamined the survey sheets and classified AP into mild (38.5%), moderate (21.8%), and severe AP (39.1%) according to the criteria proposed by Intractable Pancreatic Disease Investigation and Research Group of the Japanese Ministry of Health and Welfare. The overall mortality rate was 5.9% while that of severe cases was 13.8%. The severity scores proposed by Intractabe Pancreatic Disease Investigation and Research Group of Japanese Ministry of Health and Welfare were complicated and composed of clinical manifestations, imaging studies of computed tomography and ultrasound, and laboratory data. There was seldom a survey sheet in which the severity scores had been all described, and thus the patients were inadequately evaluated by this soring system. Thus, it was difficult to compare the severity among patients. It was therefore necessary to reduce the number of severity scores but include CRP in order to conveniently and accurately identify the severity of AP. Of 67 deaths' 38 patients (56.7%) were transferred from other hospitals, and 27 patients (40.3%) died within the first 2 weeks, mainly as a result of multiorgan failures including cardiovascular, respiratory and renal failure. Forty patients (59.7%) died after the first 2 week from complications related to infection and DIC. The patients of the former group had mainly idiopathic AP, while those of the latter group had acute exacerbation of alcoholic chronic pancreatitis. The average fluid replacement in the death cases during the first hospital day was 2,788±246 mL and the fluid replacement of 78.9% death cases was less than 3,500 mL per day. Citical issues in patient management include accurate scoring of severity in acute pancreatitis, sufficient fluid replacement at an early stage, and early transfer of patients diagnosed as severe as severe AP to a tertiary hospital.

Journal

  • Suizo

    Suizo 20 (1), 17-30, 2005

    Japan Pancreas Society

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