P2114 - Isolated Organ Failure Increases Morbidity but Not Mortality in Patients With Necrotizing Pancreatitis - A Single Tertiary Center Experience in 581 Patients

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Award: Presidential Poster Award

Presenting Author(s)

Petr Vanek, MD

Palacky University Olomouc and University Hospital
Olomouc, Olomoucky kraj, Czech Republic

Award: Presidential Poster Award

Petr Vanek, MD¹, Jana Zapletalova, PhD², David E. Jonason, MD³, Martin L. Freeman, MD³, Guru Trikudanathan, MBBS³
¹Palacky University Olomouc and University Hospital, Olomouc, Olomoucky Kraj, Czech Republic; ²Palacky University Olomouc, Olomouc, Olomoucky Kraj, Czech Republic; ³University of Minnesota Medical Center, Minneapolis, MN

Introduction: Necrotizing pancreatitis (NP) has a variable clinical course and it is essential to identify determinants associated with high risk of mortality and poor clinical outcomes. Specific clinical outcomes of NP patients with selected forms of organ failure (OF) have not been well characterized. We aimed to evaluate differences in clinical outcomes of isolated organ failure (IOF), multiple organ failure (MOF) and no persistent organ failure (NPOF) in patients with NP.

Methods: We performed a post hoc analysis of a prospectively maintained database of 581 NP patients managed at our center between 2009 to 2020. Patients diagnosed with OF on admission with evidence of persistent OF (POF, duration of OF ≥ 48h) were classified as IOF or MOF (≥ 2 organs involved) per the Modified Marshall Score. Baseline characteristics including demographics, ASA score, etiology of NP, systemic inflammatory response syndrome (SIRS) criteria, and clinical outcomes were recorded. Differences in clinical outcomes after development of selected forms of OF were evaluated using the Mann-Whitney U test, χ2 test or Fisher's exact test as appropriate. P < 0.05 was considered significant.

Results: Among 581 patients with NP, 167 (28.7%) developed POF. Mean age was 51.3 years and 391 (67.3%) were male. Thirty-six (6.2%) patients had IOF: 16 had isolated acute kidney injury (IAKI), 18 respiratory failure, and 2 cardiovascular failure. Compared to MOF, IOF patients were less likely to have SIRS at 48h of admission (58.3% vs 78.6%, P = 0.014), require intervention (47.2% vs 68.7%, P < 0.0001) or ICU admission (58.3% vs 92.4%, P < 0.0001), had shorter median total length of stay (LOS, 21.5d vs 35d, P = 0.001), lower incidence of ASA IV (2.8% vs 18.3%, P = 0.046), and lower inpatient mortality (2.8% vs 22.1%, P = 0.007). Compared to NPOF, IOF patients had a higher need for ICU admission (58.3% vs 21.5%, P < 0.0001) and longer median total LOS (21.5d vs 14d, P = 0.001), although inpatient mortality did not differ (2.8% vs 4.3%, P = 1). Comparing subtypes of IOF, IAKI required less ICU admission (31.3% vs 77.8%, P = 0.006) and had lower median ICU LOS (2d vs 8d, P = 0.034), other parameters did not significantly differ.

Discussion: Our results suggest that IOF disease trajectory is different from MOF and more similar to NPOF as mortality was not affected despite increased morbidity. Furthermore, MOF presented more likely in patients with more comorbidities given the higher number of ASA IV patients.

Figure: Figure 1 Patient cohort flowchart based on development of selected forms of organ failure. NP: Necrotizing pancreatitis; OF: Organ failure; POF: Persistent organ failure; NPOF: No persistent organ failure; IOF: Isolated organ failure; MOF: Multiple organ failure; IRF: Isolated respiratory failure; IAKI: Isolated acute kidney injury; ICVF: Isolated cardiovascular failure.

	IOF (n=36)	MOF (n=131)	P value	NPOF (n=414)	P value
Mean age (SD)	52.1 (17.9)	53.4 (15.8)	0.596	50.5 (17.3)	0.557
Male	24 (66.7%)	96 (73.3%)	0.434	271 (65.5%)	0.884
Median BMI (IQR)	29.4 (25.3-34.8)	31.0 (26.0-35.7)	0.398	27.9 (24-32)	0.211
Transfers	22 (61.1%)	84 (64.1%)	0.740	212 (50.0%)	0.254
Etiology
Biliary	7 (19.4%)	35 (26.7%)	0.373	138 (33.3%)	0.087
Alcoholic	11 (30.6%)	46 (35.1%)	0.609	139 (33.6%)	0.712
Idiopathic	9 (25.0%)	23 (17.6%)	0.315	82 (19.8%)	0.457
Drug	3 (8.3%)	8 (6.1%)	0.705	8 (1.9%)	0.017
Hypertriglyceridemia	1 (2.8%)	11 (8.4%)	0.465	20 (4.8%)	1
Post-ERCP	4 (11.1%)	5 (3.8%)	0.102	15 (3.6%)	0.056
Other	1 (2.8%)	3 (2.3%)	1	12 (2.9%)	1
ASA status
I	1 (2.8%)	2 (1.5%)		11 (2.7%)
II	11 (30.6%)	25 (19.2%)		200 (48.3%)
III	23 (63.9%)	80 (61.1%)		194 (46.9%)
IV	1 (2.8%)	24 (18.3%)	0.046	9 (2.2%)	0.144
SIRS score on admission ≥2	27 (75%)	128 (97.7%)	< 0.0001	240 (58%)	0.046
SIRS score at 48h of admission ≥2	21 (58.3%)	103 (78.6%)	0.014	92 (22.2%)	< 0.0001
Median Modified Marshall Score	3	5	< 0.0001	1	< 0.0001
ICU admission	21 (58.3%)	121 (92.4%)	< 0.0001	89 (21.5%)	< 0.0001
Median ICU LOS in days (IQR)	7 (3.0-13.0)	17 (7.5-28.0)	0.006	-	-
Need for intervention	17 (47.2%)	90 (68.7%)	< 0.0001	265 (64%)	0.046
Percutaneous drainage	12 (33.3%)	44 (33.6%)	0.977	79 (19.1%)	0.041
Endoscopic drainage	12 (33.3%)	72 (55%)	0.022	233 (56.3%)	0.008
Median # of DEN sessions (IQR)	2 (1-4)	2 (1-4)	0.579	-	-
Surgical drainage	3 (8.3%)	24 (18.3%)	0.149	24 (5.8%)	0.467
Median total LOS in days (IQR)	21.5 (14-44)	35 (26-62)	0.001	14 (7-26)	0.001
In-patient mortality	1 (2.8%)	29 (22.1%)	0.007	18 (4.3)	1
30-day unplanned readmission	8 ( 22.2%)	17 (13%)	0.169	82 (19.8%)	0.728

Table: Table 1 Characteristics, Severity Predictors and Clinical Outcomes in Specific Subgroups of Patients With Necrotizing Pancreatitis.

P values: 1st column reflects comparison of IOF to MOF, 2nd column reflects comparison of IOF to NPOF. IOF: Isolated organ failure; MOF: Multiple organ failure; NPOF: No persistent organ failure; SD: Standard deviation; BMI: Body mass index; IQR: Interquartile range; ASA: American Society of Anestelogists; SIRS: Systemic infammatory response syndrome; ICU: Intensive care unit; LOS: Length of stay; DEN: Direct endoscopic necrosectomy.

Disclosures:

Petr Vanek indicated no relevant financial relationships.

Jana Zapletalova indicated no relevant financial relationships.

David Jonason indicated no relevant financial relationships.

Martin Freeman indicated no relevant financial relationships.

Guru Trikudanathan indicated no relevant financial relationships.

Petr Vanek, MD¹, Jana Zapletalova, PhD², David E. Jonason, MD³, Martin L. Freeman, MD³, Guru Trikudanathan, MBBS³. P2114 - Isolated Organ Failure Increases Morbidity but Not Mortality in Patients With Necrotizing Pancreatitis - A Single Tertiary Center Experience in 581 Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.