SS  Vol.3 No.12 , December 2012
The Risk Factors of Intensive Care Unit Admittance during First Attack of Acute Pancreatitis
Abstract: Background: A proportion of patients with acute pancreatitis develop severe organ dysfunction requiring admittance in an intensive care unit. Patient characteristics associated with ICU admittance were evaluated in this consecutive series of patients. Methods: The clinical course of patients with first attack of acute pancreatitis in urban Norway between 01.01.1996 and 31.12.2006 was reviewed. Patient characteristics, comorbidity, pre hospital delay and likely aetiology of acute pancreatitis were analysed as risk factors for ICU admittance. Results: This study includes 565 patients, 299 women and 266 men (p = 0.089), with a median age of 60 years (range: 17 - 98). 50 (9%) of the patients were admitted to the ICU. Men were more at risk than women for ICU admittance (OR 2.34; 95% CI: 1.27 - 4.32). Patients with alcohol associated pancreatitis (OR 5.94; 95%, CI: 2.61 - 13.53), miscellaneous aetiologies (OR: 2.81, 95% CI: 1.02 - 7.73) and non-assessed aetiology (OR: 2.71, 95%, CI: 1.26 - 5.82) were more at risk of ICU admittance than patients with bile stones associated pancreatitis. Pre hospital delay increased the risk of ICU admittance amongst patients with alcohol associated pancreatitis (OR: 4.23; 95%, CI: 1.11 - 16.18). Two comorbid conditions conveyed increased risk (OR: 8.78; 95%, CI: 1.87 - 41.22). The case fatality rate was 24% in the ICU and 1.6% in the ward (OR 20.01, 95% CI: 7.71 - 51.93). Conclusions: Aetiology of acute pancreatitis, especially alcohol, pre-hospital delay and male gender are associated with increased of risk of ICU admittance and increased fatality rate during first attack of AP.
Cite this paper: J. Dale, T. Omdal, S. Lie, K. Iversen, H. Flaaten and K. Ovrebo, "The Risk Factors of Intensive Care Unit Admittance during First Attack of Acute Pancreatitis," Surgical Science, Vol. 3 No. 12, 2012, pp. 603-613. doi: 10.4236/ss.2012.312118.

[1]   D. N. Schmidt, “Apparent Risk Factors for Chronic and Acute Pancreatitis in Stockholm County. Spirits But not Wine and Beer,” International Journal of Pancreatology, Vol. 8, No. 1, 1991, pp. 45-50.

[2]   P. A. Banks, “Epidemiology, Natural History, and Predictors of Disease Outcome in Acute and Chronic Pancreatitis,” Gastrointestinal Endoscopy, Vol. 56, No. 6, 2002, pp. 226-230. doi:10.1016/S0016-5107(02)70016-3

[3]   T. Omdal, J. Dale, S. A. Lie, K. B. Iversen, H. Flaaten and K. K. Ovrebo, ”Time Trends in Incidence, Etiology, and Case fatality Rate of the First Attack of Acute Pancreatitis,” Scandinavian Journal of Gastroenterology, Vol. 46, No. 11, 2011, pp. 1389-1398. doi:10.3109/00365521.2011.605464

[4]   H. Gislason, A. Horn, D. Hoem, A. Andren-Sandberg, A. K. Imsland, O. Soreide, et al., “Acute Pancreatitis in Bergen, Norway. A Study on Incidence, Etiology and Severity,” Scandinavian Journal of Gastroenterology, Vol. 93, No. 1, 2004, pp. 29-33.

[5]   H. E. Lilja, A. Leppaniemi and E. Kemppainen, “Utilization of Intensive Care Unit Resources in Severe Acute Pancreatitis,” Journal of the Pancreas, Vol. 9, No. 2, 2008, pp. 179-184.

[6]   J. Mayerle, V. Hlouschek and M. M. Lerch, “Current Management of Acute Pancreatitis,” Nature Clinical Practice Gastroenterology & Hepatology, Vol. 2, No. 10, 2005, pp. 473-483. doi:10.1038/ncpgasthep0293

[7]   H. G. Beger and B. M. Rau, “Severe Acute Pancreatitis: Clinical Course and Management,” World Journal of Gastroenterology, Vol. 13, No. 38, 2007, pp. 5043-5051.

[8]   S. R. Eachempati, L. J. Hydo and P. S. Barie, “Severity Scoring for Prognostication in Patients with Severe Acute Pancreatitis: Comparative Analysis of the Ranson Score and the APACHE III Score,” Archives of Surgery, Vol. 137, No. 6, 2002, pp. 730-736. doi:10.1001/archsurg.137.6.730

[9]   M. Williams and H. H. Simms, “Prognostic Usefulness of Scoring Systems in Critically Ill Patients with Severe Acute Pancreatitis,” Critical Care Medicine, Vol. 27, No. 5, 1999, pp. 901-907. doi:10.1097/00003246-199905000-00023

[10]   P. W. Vriens, P. van de Linde, E. T. Slotema, P. E. Warmerdam and P. J. Breslau, ”Computed Tomography Severity Index Is an Early Prognostic Tool for Acute Pancreatitis,” Journal of the American College of Surgeons, Vol. 201, No. 4, 2005, pp. 497-502. doi:10.1016/j.jamcollsurg.2005.06.269

[11]   D. Juneja, P. B. Gopal and M. Ravula, “Scoring Systems in Acute Pancreatitis: Which One to Use in Intensive Care Units,” Journal of Critical Care, Vol. 25, No. 2, 2010, pp. e9-e15.

[12]   E. Gocmen, Y. A. Klc, O. Yoldas, T. Ertan, N. Karakose, M. Koc, et al., “Comparison and Validation of Scoring Systems in a Cohort of Patients Treated for Biliary Acute Pancreatitis,” Pancreas, Vol. 34, No. 1, 2007, pp. 66-69. doi:10.1097/01.mpa.0000246667.53622.e3

[13]   T. K. Leung, C. M. Lee, S. Y. Lin, H. C. Chen, H. J. Wang, L. K. Shen, et al., “Balthazar Computed Tomography Severity Index Is Superior to Ranson Criteria and APACHE II Scoring System in Predicting Acute Pancreatitis Outcome,” World Journal of Gastroenterology, Vol. 11, No. 38, 2005, pp. 6049-6052.

[14]   T. E. Pavlidis, E. T. Pavlidis and A. K. Sakantamis Advances in Prognostic Factors in Acute Pancreatitis: A Mini-Review. Hepatobiliary & Pancreatic Diseases International, Vol. 9, No. 5, 2010, pp. 482-486.

[15]   G. Gravante, G. Garcea, S. L. Ong, M. S. Metcalfe, D. P. Berry, D. M. Lloyd, et al., “Prediction of Mortality in Acute Pancreatitis: A Systematic Review of the Published Evidence,” Pancreatology, Vol. 9, No. 5, 2009, pp. 601-614. doi:10.1159/000212097

[16]   M. Abu-Hilal and T. Armstrong, “The Impact of Obesity on the Course and Outcome of Acute Pancreatitis,” Obesity Surgery, Vol. 18, No. 3, 2008, pp. 326-328. doi:10.1007/s11695-007-9298-5

[17]   L. Company, J. Saez, J. Martinez, J. R. Aparicio, R. Laveda, P. Grino, et al., “Factors Predicting Mortality in Severe Acute Pancreatitis,” Pancreatology, Vol. 3, No. 2, 2003, pp. 144-148. doi:10.1159/000070083

[18]   D. Yadav and D. C. Whitcomb, “The Role of Alcohol and Smoking in Pancreatitis,” Nature Reviews Gastroenterology & Hepatology, Vol. 7, No. 3, 2010, pp. 131-145. doi:10.1038/nrgastro.2010.6

[19]   J. D. Wig, K. G. Bharathy, R. Kochhar, T. D. Yadav, A. K. Kudari, R. P. Doley, et al., “Correlates of Organ Failure in Severe Acute Pancreatitis,” Journal of the Pancreas, Vol. 10, No. 3, 2009, pp. 271-275.

[20]   J. L. Mee, F. Paye, A. Sauvanet, D. O’Toole, P. Hammel, J. Marty, et al., “Incidence and Reversibility of Organ Failure in the Course of Sterile or Infected Necrotizing Pancreatitis,” Archives of Surgery, Vol. 136, No. 12, 2009, pp. 1386-1390. doi:10.1001/archsurg.136.12.1386

[21]   A. Buter, C. W. Imrie, C. R. Carter, S. Evans and C. J. Mc-Kay, “Dynamic Nature of Early Organ Dysfunction Determines Outcome in Acute Pancreatitis,” British Journal of Surgery, Vol. 89, No. 3, 2002, pp. 298-302. doi:10.1046/j.0007-1323.2001.02025.x

[22]   D. Radenkovic, D. Bajec, N. Ivancevic, N. Milic, V. Bumbasirevic, V. Jeremic, et al., “D-Dimer in Acute Pancreatitis: A New Approach for an Early Assessment of Organ Failure. Pancreas, Vol. 38, No. 6, 2009, pp. 655-660. doi:10.1097/MPA.0b013e3181a66860

[23]   E. L. Bradley, “A Clinically Based Classification System for Acute Pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11-13, 1992,” Archives of Surgery, Vol. 128, No. 5, 1993, pp. 586-590. doi:10.1001/archsurg.1993.01420170122019

[24]   C. Frey, H. Zhou, D. Harvey and R. H. White, “Co-Morbidity Is a Strong Predictor of Early Death and Multi-Organ System Failure among Patients with Acute Pancreatitis,” Journal of Gastrointestinal Surgery, Vol. 11, No. 6, 2007, pp. 733-742. doi:10.1007/s11605-007-0164-5

[25]   N. Ahmadi, D. Shavelle, V. Nabavi, F. Hajsadeghi, S. Moshrefi, F. Flores, et al., “Coronary Distensibility Index Measured by Computed Tomography Is Associated with the Severity of Coronary Artery Disease,” Journal of Cardiovascular Computed Tomography, Vol. 4, No. 2, 2010, pp. 119-126. doi:10.1016/j.jcct.2010.01.007

[26]   K. I. Halonen, A. K. Leppaniemi, P. A. Puolakkainen, J. E. Lundin, E. A. Kemppainen, A. J. Hietaranta, et al., “Severe Acute Pancreatitis: Prognostic Factors in 270 Consecutive Patients,” Pancreas, Vol. 21, No. 3, 2000, pp. 266-271. doi:10.1097/00006676-200010000-00008

[27]   H. N. Shen and C. L. Lu, “Incidence, Resource Use, and Outcome of Acute Pancreatitis with/without Intensive Care: A Nationwide Population-Based Study in Taiwan,” Pancreas, Vol. 40, No. 1, 2011, pp. 10-15. doi:10.1097/MPA.0b013e3181f7e750

[28]   T. Bruennler, O. W. Hamer, S. Lang, S. Gruene, C. E. Wrede, N. Zorger, et al., “Outcome in a Large Unselected Series of Patients with Acute Pancreatitis,” Hepatogastroenterology, Vol. 56, No. 91-92, 2009, pp. 871-876.

[29]   J. P. Neoptolemos, M. Raraty, M. Finch and R. Sutton, “Acute Pancreatitis: The Substantial Human and Financial Costs. Gut, Vol. 42, No. 6, 1998, pp. 886-891. doi:10.1136/gut.42.6.886.

[30]   T. A. Williams, G. J. Dobb, J. C. Finn, M. W. Knuiman, E Geelhoed, K. Y. Lee, et al., “Determinants of Long-Term Survival after Intensive Care,” Critical Care Medicine, Vol. 36, No. 5, 2008, pp. 1523-1530. doi:10.1097/CCM.0b013e318170a405

[31]   B. Sandzen, M. Rosenmuller, M. M. Haapamaki, E. Nilsson, H. C. Stenlund and M. Oman, “First Attack of Acute Pancreatitis in Sweden 1988-2003: Incidence, Aetiological Classification, Procedures and Mortality—A Register Study,” BMC Gastroenterology, Vol. 9, No. 5, 2009, p. 18. doi:10.1186/1471-230X-9-18

[32]   P. G. Lankisch, C. Assmus, D. Pflichthofer, K. Struckmann and D. Lehnick, “Which Etiology Causes the Most Severe Acute Pancreatitis,” International Journal of Pancreatology, Vol. 26, No. 2, 1999, pp. 55-57. doi:10.1007/BF02781731

[33]   J. Vandervoort, R. M. Soetikno, T. C. Tham, R. C. Wong, A. P. Ferrari, H. Montes, et al., “Risk Factors for Complications after Performance of ERCP,” Gastrointestinal Endoscopy, Vol. 56, No. 5, 2002, pp. 652-656. doi:10.1016/S0016-5107(02)70112-0

[34]   J. Huang, C. H. Chang, J. L. Wang, H. K. Kuo, J. W. Lin, W. Y. Shau, et al., “Nationwide Epidemiological Study of Severe Gallstone Disease in Taiwan,” BMC Gastroenterology, Vol. 9, No. 22, 2009, p. 63. doi:10.1186/1471-230X-9-63

[35]   G. J. Wang, C. F. Gao, D. Wei, C. Wang and S. Q. Ding, “Acute Pancreatitis: Etiology and Common Pathogenesis,” World Journal of Gastroenterology, Vol. 15, No. 12, 2009, pp. 1427-1430. doi:10.3748/wjg.15.1427

[36]   M. L. Freeman, J. A. DiSario, D. B. Nelson, M. B. Fennerty, J. G. Lee, D. J. Bjorkman, et al., “Risk Factors for Post-ERCP Pancreatitis: A Prospective, Multicenter Study,” Gastrointestinal Endoscopy, Vol. 54, No. 4, 2001, pp. 425-434. doi:10.1067/mge.2001.117550

[37]   B. T. Fevang, J. M. Fevang, O. Soreide, K. Svanes and A. Viste, “Delay in Operative Treatment among Patients with Small Bowel Obstruction,” Scandinavian Journal of Surgery, Vol. 92, No. 2, 2003, pp. 131-137.

[38]   C. Svanes, R. T. Lie, K. Svanes, S. A. Lie and O. Soreide, “Adverse Effects of Delayed Treatment for Perforated Peptic Ulcer,” Annals of Surgery, Vol. 220, No. 2, 1994, pp. 168-175. doi:10.1097/00000658-199408000-00008

[39]   I. Glambek, G. Kvaale, B. Arnesjo and O. Soreide, “Prevalence of Gallstones in a Norwegian Population,” Scandinavian Journal of Gastroenterology, Vol. 22, No. 9, 1987, pp. 1089-1094. doi:10.3109/00365528708991963

[40]   R. Andersson, B. Andersson, P. Haraldsen, G. Drewsen and G. Eckerwall, “Incidence, Management and Recurrence Rate of Acute Pancreatitis,” Scandinavian Journal of Gastroenterology, Vol. 39, No. 9, 2004, pp. 891-894. doi:10.1080/00365520410007061

[41]   C. Nojgaard, F. Bendtsen, P. Matzen and U. Becker, “The Aetiology of Acute and Chronic Pancreatitis over Time in a Hospital in Copenhagen,” Danish Medical Bulletin, Vol. 57, No. 1, 2010, p. A4103.