Results of the Management of 271 Severe Acute Pancreatitis
Seance of wednesday 09 september 2020 (Communications libres)
DOI number : 10.26299/q1nh-dc30/emem.2019.1.002
Abstract
Acute pancreatitis (AP) can be potentially serious in 20 to 30% of cases accompanied by multiple and local systemic complications, early or late. In its necrotizing form it can be complicated by necrosis infection, a formidable complication with heavy morbidity and mortality. Its management depends on the severity of the AP assessed by the score of the systemic inflammatory response syndrome (SIRS) and by the presence of organ failures. The treatment is mainly symptomatic apart from the biliary AP, the most common etiology, with cholecystectomy and obstruction of the bile ducts. The mortality of severe AP (PAS) can reach up to 50%. Pancreatic necrosis infection (PNI) is the main prognostic factor for the progression of BP. Its treatment has become more conservative and less invasive, but there is little data from prospective studies to confirm the effectiveness of this change.
Aims: The aim of the study is to provide epidemiological, evolutionary (morbi-mortality) and long-term outcome data for 271 patients with PAS.
Material and methods: This is a single-center longitudinal study of patients with PAS admitted between January 2010 and December 2019 with a prospective standardized collection of clinical, biological, morphological, and evolutionary data from 271 PAS patients (severity defined according to the Atlanta criteria 2012) with the main evaluation parameters: morbidity and mortality, length of hospital stay. The biostatistical study was carried out with SPSS R 3.4.1 software.
Results: Our study have concerned 271 AP cases. The average age of our patients is 51.4 years with a female predominance of 72%. The clinical status included a SIRS of 3.048, BMI of 26.31, an intra-abdominal pressure (IAP) at 15.5 mm Hg. The average CT severity index is evaluated at 7.8. A co-morbidity is found in 46.12% of our patients. Biliary etiology accounted for 55.9% of cases, idiopathic AP; 21.85% and alcoholic; 9.63%. Cholecystectomy was possible in 78.14%, with an average conversion rate of 38.14%. The number of failing organs and the duration of organ failure were good prognosis indices for mortality. The rate of pancreatic necrosis infection (PNI) was 18.45%, with a mortality of 34% and an increased risk of developing diabetes in the long term. Antibiotic prophylaxis was instituted in 23.61% of patients, without any impact on the occurrence of INP and mortality. The length of stay at the hospital was 28 days (mean stay 25 days), with ranges of 25 to 264 days. Morbidity and overall mortality were respectively 45.01% and 29.15%.
Conclusions: Standardization of the management of BP, after identification of the etiology and early assessment of its severity, could allow optimal management of the disease and prevent its progression. The multidisciplinary contribution is essential to manage comorbidities, systemic failures and septic complications. The “step up approach” strategy must henceforth guide the management and prognosis of patients. The evolution of conservative treatment in recent years has reduced the need for surgery and reduced morbidity and mortality. Our work reveals that the publication of Guidelines alone is insufficient to change practice and raises the question of how best to communicate the recommendations of learned societies.
Aims: The aim of the study is to provide epidemiological, evolutionary (morbi-mortality) and long-term outcome data for 271 patients with PAS.
Material and methods: This is a single-center longitudinal study of patients with PAS admitted between January 2010 and December 2019 with a prospective standardized collection of clinical, biological, morphological, and evolutionary data from 271 PAS patients (severity defined according to the Atlanta criteria 2012) with the main evaluation parameters: morbidity and mortality, length of hospital stay. The biostatistical study was carried out with SPSS R 3.4.1 software.
Results: Our study have concerned 271 AP cases. The average age of our patients is 51.4 years with a female predominance of 72%. The clinical status included a SIRS of 3.048, BMI of 26.31, an intra-abdominal pressure (IAP) at 15.5 mm Hg. The average CT severity index is evaluated at 7.8. A co-morbidity is found in 46.12% of our patients. Biliary etiology accounted for 55.9% of cases, idiopathic AP; 21.85% and alcoholic; 9.63%. Cholecystectomy was possible in 78.14%, with an average conversion rate of 38.14%. The number of failing organs and the duration of organ failure were good prognosis indices for mortality. The rate of pancreatic necrosis infection (PNI) was 18.45%, with a mortality of 34% and an increased risk of developing diabetes in the long term. Antibiotic prophylaxis was instituted in 23.61% of patients, without any impact on the occurrence of INP and mortality. The length of stay at the hospital was 28 days (mean stay 25 days), with ranges of 25 to 264 days. Morbidity and overall mortality were respectively 45.01% and 29.15%.
Conclusions: Standardization of the management of BP, after identification of the etiology and early assessment of its severity, could allow optimal management of the disease and prevent its progression. The multidisciplinary contribution is essential to manage comorbidities, systemic failures and septic complications. The “step up approach” strategy must henceforth guide the management and prognosis of patients. The evolution of conservative treatment in recent years has reduced the need for surgery and reduced morbidity and mortality. Our work reveals that the publication of Guidelines alone is insufficient to change practice and raises the question of how best to communicate the recommendations of learned societies.