Analysis And Prediction Of Death In Severe Acute Pancreatitis

Background:Severe acute pancreatitis (SAP) is a kind of fatal acute abdomen of much complications and high mortality rate, patients mostly die of multiple organ dysfunction (MODS) in the early two weeks from onset or advanced infection related complications in the late fase. Therefore, evaluate the prognosis of patients during the course of treatment using the laboratory data and clinical characteristics is very important, especially the emergency evaluation of early death in the admission. This clinical investigation aims to find the factors related to death or early death from clinical features and biological parameters, and discuss the parameters that can forecast the death outcome especially early death.Purpose:Fifteen death cases with SAP during the past five years were retrospectively analysed in all department of Shandong Provincial Hospital. To summarize the clinical and lab character of the15dead patients, aiming to find the death related factors using statistical methods. So we can improve the therapeutic method in order to reduce the mortality rate of SAP.Methods:Between January2007and December2011details of171patients with severe acute pancreatitis (SAP) were retrospectively analysed in Shandong Provincial Hospital. This investigation discusses the related risk factors for SAP death according to the cause, clinical characteristics, laboratory data, complications and death rate.Results:1. In the747patients with acute pancreatitis in the past five years, there were171severe cases, accounting for22.6%of the acute pancreatitis cases. The Severe acute pancreatitis patients have a mortality rate of8.77%(15/171). There were13males and2females in the death group.2. The mean onset age of patients with severe acute pancreatitis were51.62±16.69(range25to83), the average length of stay were23±22days (range1to80days). In causes of the severe acute pancreatitis patients gallstone accounted for49.1%(84/171), and the alcoholic factors accounted for only15.2%(26/171), stating that in our hospital gallstone is the main cause of severe acute pancreatitis.3. We divided the171SAP patients into two groups-death and survival group. Between the two groups, causes, blood AMS, ALT etc. were not associated with death (P>0.05). Well, age, sex, MODS, extent of necrosis, infection of necrotic pancrease and APACHE Ⅱ score were significantly associated with death (P<0.05), especially MODS (P<0.01). Multivariate analysis revealed that infection was the only independent risk factor.4. Between the early-death and early-survival groups, significant factors were the mean age, sex, base excess (BE), serum creatinine (sCr), BUN and AST.Conclusions:1. The mortality of severe acute pancreatitis is still high. MODS is the main cause of early death. Infection of pancreatic necrosis and its complications is the main cause of later death.2. The high risk factor resulted in death are elder age, male, MODS, extent of necrosis, infection of necrotic pancrease and APACHE-Ⅱ score, especially MODS. Multivariate analysis revealed that infection was the only independent risk factor.3. Between the early-death and early-survival groups, the early death risk factors were the mean age, sex, base excess (BE), serum creatinine (sCr), BUN, AST, and APACHE-Ⅱ score, especially BE and APACHE-Ⅱ score. So maybe BE, sCr and BUN could predict early death instead of the traditional score system.4. Patients in our hospital with SAP mostly dead early after admission. We should pay attention to the support therapy of early organ function in SAP and control the complications actively, especially the aged patients. The operative opportunity and infection control in the late phase are the key points to decrease the mortality in SAP.