Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit-Treated Patients with Necrotizing Severe Acute Pancreatitis

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Husu , HL , Valkonen , MM , Leppaniemi , AK & Mentula , PJ 2021 , ' Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit-Treated Patients with Necrotizing Severe Acute Pancreatitis ' , Journal of Gastrointestinal Surgery , vol. 25 , no. 9 , pp. 2289-2298 . https://doi.org/10.1007/s11605-021-05033-x

Title: Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit-Treated Patients with Necrotizing Severe Acute Pancreatitis
Author: Husu, HL; Valkonen, MM; Leppaniemi, AK; Mentula, PJ
Contributor: University of Helsinki, Doctoral Programme in Clinical Research
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
Date: 2021-09
Language: eng
Number of pages: 10
Belongs to series: Journal of Gastrointestinal Surgery
ISSN: 1091-255X
URI: http://hdl.handle.net/10138/336490
Abstract: Background In patients with severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) is associated with a worsened outcome. We studied risk factors and consequences of IPN in patients with necrotizing SAP. Methods The study consisted of a retrospective cohort of 163 consecutive patients treated for necrotizing SAP at a university hospital intensive care unit (ICU) between 2010 and 2018. Results All patients had experienced at least one persistent organ failure and approximately 60% had multiple organ failure within the first 24 h from admission to the ICU. Forty-seven (28.8%) patients had IPN within 90 days. Independent risk factors for IPN were more extensive anatomical spread of necrotic collections (unilateral paracolic or retromesenteric (OR 5.7, 95% CI 1.5-21.1) and widespread (OR 21.8, 95% CI 6.1-77.8)) compared to local collections around the pancreas, postinterventional pancreatitis (OR 13.5, 95% CI 2.4-76.5), preceding bacteremia (OR 4.8, 95% CI 1.3-17.6), and preceding open abdomen treatment for abdominal compartment syndrome (OR 3.6, 95% CI 1.4-9.3). Patients with IPN had longer ICU and overall hospital lengths of stay, higher risk for necrosectomy, and higher readmission rate to ICU. Conclusions Wide anatomical spread of necrotic collections, postinterventional etiology, preceding bacteremia, and preceding open abdomen treatment were identified as independent risk factors for IPN.
Subject: Infected pancreatic necrosis
Intensive care unit
Multiple organ failure
Organ failure
Prophylactic antibiotics
Severe acute pancreatitis
Necrotizing pancreatitis
EARLY ANTIBIOTIC-TREATMENT
ORGAN FAILURE
DOUBLE-BLIND
ENTERAL NUTRITION
EUROPEAN-SOCIETY
CLASSIFICATION
DETERMINANTS
MANAGEMENT
MORTALITY
STERILE
3126 Surgery, anesthesiology, intensive care, radiology
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