Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality
Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality
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DOI：
10.1111/j.1572-0241.2007.01446.x
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发表时间：
2007-12-01
影响因子：
9.8
通讯作者：
Garg, Pramod K.
中科院分区：
文献类型：
--
作者：
Sharma, Manik;Banerjee, Debabrata;Garg, Pramod K.
背景：急性胰腺炎(AP)的危险分层非常重要。目的：对早期重症胰腺炎患者进行特征分析，找出严重程度的危险因素，并评估其预后。根据APACHE II评分、器官衰竭(OF)的存在和强度进行严重程度评估。重症胰腺炎患者分为早期重症胰腺炎和晚期重症急性胰腺炎。早期重症急性胰腺炎(ESAP)的判断标准为胰腺炎后7d内病情严重。结果：282例急性胰腺炎患者中，轻度AP 144例(51%)，ESAP 32例(11.34%)，晚期重症AP 106例(37.58%)。在ESAP患者(平均年龄45.4岁，22名男性)中，10名患者为暴发性AP，22名患者为亚暴发性AP。与晚期重症AP患者相比，ESAP患者入院APACHE II评分较高(14.9vs8.8，P<；0.001)。重症急性胰腺炎并发多器官功能衰竭的比例明显高于晚期重症急性胰腺炎(75%比26%，P<；0.001)。暴发型、亚暴发型和晚期重症急性胰腺炎的死亡率差异显著(90%、72.7%和30%；P<；0.001)。ESAP患者占所有死亡人数的44%。死亡率的预测因素是发展和器官衰竭的早期发病。结论：我们描述了暴发性和亚暴发性AP患者的新亚组，具有重要的预后和治疗意义。
BACKGROUND: Risk stratification of acute pancreatitis (AP) is important.OBJECTIVE: To characterize patients with early severe pancreatitis, identify risk factors of severity, and assess their outcome.METHODS: All consecutive patients with AP were included in the study. Severity assessment was done by APACHE II score, and presence and intensity of organ failure (OF). OF was graded from 1 to 4. Patients with severe pancreatitis were divided into early severe and late severe AP. The criterion for early severe AP (ESAP) was severe OF within 7 days of pancreatitis. Patients with ESAP were subdivided into fulminant and subfulminant AP based on timing of OF, i.e., < 72 h and between 4 and 7 days of pancreatitis, respectively.RESULTS: Of 282 patients with AP, 144 (51%) had mild AP, 32 (11.34%) had ESAP, and 106 (37.58%) had late severe AP. Of the ESAP patients (mean age 45.4 yr, 22 men), 10 patients had fulminant AP and 22 had subfulminant AP. Patients with ESAP had higher admission APACHE II compared to patients with late severe AP (14.9 vs 8.8, P < 0.001). The proportion of patients with multiorgan failure was significantly higher in ESAP compared with late severe AP (75% vs 26%, P < 0.001). The difference in mortality was significant in the fulminant, subfulminant, and late severe AP (90%, 72.7%, and 30%; P < 0.001). Patients with ESAP accounted for 44% of all deaths. Predictors of mortality were development and early onset of organ failure.CONCLUSIONS: We have characterized newer subgroups of patients with fulminant and subfulminant AP with important prognostic and management implications.