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Extended Pancreatic Necrosis Patients Die More From Organ Failure Than Pancreatitis

Deaths of patients with extended pancreatic necrosis and infected necrosis are usually due to organ failure at hospital rather than increasingly severe necrotising pancreatitis.

Investigators, based at the University of California, San Francisco, United States, reviewed 1,110 consecutive cases of acute pancreatitis over a five-year period.

They had previously found in smaller groups of patients that organ failure occurred in half of those with necrotising pancreatitis. They had also found that extended necrosis (>50 percent) was not associated with more organ failure or infected necrosis, and that the prevalence of organ failure in sterile and infected necrosis was similar.

The investigators now analysed these relationships in this larger group of patients. They also evaluated other factors which might have prognostic significance.

Necrosis was documented by contrast-enhanced computerised tomography. A value less than 0.05 was considered significant.

Of the 1,110 patients, 99 (8.9 percent) had necrotising pancreatitis and 52 percent had organ failure.

Patients with extended pancreatic necrosis did not have increased prevalence of organ failure or infected necrosis but did need more intubation. They also had a higher death rate associated with multiple organ failure.

Patients with infected necrosis did not have a greater prevalence of organ failure but did have marginally more multiple organ failures and increased need for intubation.

Overall mortality was 14 percent. Mortality was markedly higher among patients with organ failure at admission (47 percent) and in those who had multiple organ failure during hospitalisation (49 percent).
Pancreas 2002; 25(3):229-233. "Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis?"

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