SEVERE PANCREATITIS - DETERMINANTS OF MORTALITY IN A TERTIARY REFERRAL CENTER

Objective: To determine factors associated with mortality in patients with severe pancreatitis. Design: Retrospective review. Setting: Unive rsity tertiary referral center intensive care unit (ICU). Patients: Th irty patients admitted to the ICU with the primary diagnosis of pancre atitis from 1986 to 1995. Main Outcome Measure: Survival vs nonsurviva l. Results: Twenty-seven patients were transferred from another instit ution. At the time of ICU admission, subsequent death was not associat ed with the following: systolic blood pressure, pulse rate, hemoglobin level, leukocyte count, platelet count, or serum calcium concentratio n. The patients who died during the study were older at admission (age [mean+/-SD] of those who lived, 47+/-17 years; age of those who died, 64+/-8 years; P=.01) and their serum creatinine concentrations were h igher (creatinine concentrations [mean+/-SD] of those who lived, 150+/ -90 mu mol/L [1.7+/-1.0 mg/dL]; creatinine concentrations of those who died, 410+/-250 mu mol/L [4.6+/-2.8 mg/dL]; P=.001). Clinical events not associated with mortality included respiratory failure, insulin us e, positive blood cultures, positive pancreatic cultures, and abdomina l surgery for pancreatitis and infected pancreatic necrosis. Death was associated with the use of inotropic and/or vasopressor support (P=.0 5) and renal failure (creatinine, >170 mu mol/L [>2.0 mg/dL]) at any t ime during the ICU stay (P=.01). Patients with renal failure were no o lder than the patients without, but were admitted later after the onse t of pancreatitis (mean-C-SD, 5.9+/-7.2 days vs 1.5+/-1.1 days; P=.03; median, 2 days vs 1 days). Conclusions: After hospital transfer to a tertiary referral center, only older age, use of inotropic and/or vaso pressor support, and evidence of renal malfunction are associate. with death. Prompt recognition of severe pancreatitis, especially in older patients, aggressive hemo-dynamic management, and/or earlier transfer to a tertiary care center may diminish the incidence of renal failure and mortality in severe pancreatitis.