Comorbidity in acute pancreatitis relates to organ failure but not to local complications

Abstract

Objective: Organ failure and local complications contribute to morbidity and mortality in acute pancreatitis. Comorbidity is known to be related to organ failure. The impact of comorbidity on local complications has not yet been delineated. Moreover, it is not clear if the outcome of first-attacks and acute-on-chronic episodes, respectively, differs from outcome in all episodes.

Methods: Consecutive cases of confirmed acute pancreatitis in a four-year period were reviewed. Charlson comorbidity index (CCI), complications (organ failure and local complications), disease severity (according to the revised Atlanta Classification), need for intensive care, and mortality were derived from the charts.

Results: A total of 391 episodes of acute pancreatitis were included. Patients with organ failure were significantly older (P< 0.001) und had a higher CCI (P< 0.001) than patients without organ failure. Patients with and without local complications did not significantly differ in age or CCI. The complication rate of the entire cohort (n = 391; 47.1 %) was comparable with the complication rate of first-attacks (n = 269; 46.8 %) and acute-on-chronic episodes (n = 68; 47.1 %). The majority of the twelve deceased patients had been old and/or chronically ill. Six of these patients had an advanced malignant disease.

Conclusions: Comorbidity and age clearly are contributors to organ failure and mortality. Local complications occur independently of age and concomitant diseases. The overall complication rate is not significantly influenced by preceding inflammation of the pancreas. To further improve care in patients with acute pancreatitis special attention should be given to old and multi-morbid patients.

Zusammenfassung

Hintergrund: Organversagen und lokale Komplikationen tragen zur Morbidität und Mortalität der akuten Pankreatitis bei. Die Komorbidität erhöht das Risiko für Organversagen. Der Einfluss von Komorbidität auf lokale Komplikationen ist nicht bekannt. Außerdem ist nicht bekannt, ob das Outcome von Erstereignissen bzw. Ereignissen auf dem Boden einer chronischen Pankreatitis sich von dem Outcome unterscheidet, wenn alle Ereignisse zusammen betrachtet werden.

Methoden: Es wurden konsekutive Fälle einer bestätigten akuten Pankreatitis in einem Vierjahreszeitraum untersucht. Charlson Comorbidity Index (CCI), Komplikationen (Organversagen und lokale Komplikationen), Schweregrad (nach der revidierten Atlanta-Klassifikation), Intensivpflichtigkeit und Mortalität wurden den Krankenakten entnommen.

Ergebnisse: Insgesamt wurden 391 Ereignisse einer akuten Pankreatitis untersucht. Patienten mit Organversagen waren signifikant älter (P< 0,001) und hatten einen höheren CCI (P< 0,001) als Patienten ohne Organversagen. Patienten mit und ohne lokale Komplikationen unterschieden sich nicht hinsichtlich Alter oder CCI. Die Komplikationsrate der gesamten Kohorte (n = 391; 47,1 %) war vergleichbar mit der Komplikationsrate von Erstereignissen (n = 269; 46,8 %) und Ereignissen auf dem Boden einer chronischen Pankreatitis (n = 68; 47,1 %). Die 12 verstorbenen Patienten waren alt und/oder chronisch krank. Sechs dieser Patienten hatten ein fortgeschrittenes Krebsleiden.

Schlussfolgerung: Komorbidität und Alter sind eindeutige Faktoren, die zu Organversagen und Sterblichkeit bei der akuten Pankreatitis beitragen. Lokale Komplikationen treten unabhängig von Alter und Begleiterkrankungen auf. Die Gesamtrate an Komplikationen hängt nicht wesentlich von vorausgegangenen Entzündungen des Pankreas ab. Zur Verbesserung der Behandlung der akuten Pankreatitis sollte das Augenmerk auf alte und multimorbide Patienten gerichtet werden.

Schlüsselwörter

akute Pankreatitis - Komorbidität - Organversagen - lokale Komplikationen - Mortalität

Key words

acute pancreatitis - comorbidity - organ failure - local complications - mortality

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