Early infection is an independent risk factor for increased mortality in patients with culture-confirmed infected pancreatic necrosis

Robert A. Moran, Christopher Halloran, Qiang Guo, Chandra Umapathy, Niloofar Y. Jalaly, Saransh Jain, Darren Cowzer, Enrique Perez Cuadrado Robles, Noé Quesada-Vázquez, Andrea Szentesi, Mária Papp, Tiffany Chua, Katalin Márta, Kartik Sampath, David X. Jin, Shaheel Mohammad Sahebally, Tobias Philipp Kuschnereit, Mouen A. Khashab, Clare Rock, Erika DarvasiRebecca Saunders, Guillermo García-Rayado, Yolanda Sánchez Torrijos, Laoise Coady, Georgios I. Papachristou, Julia Mayerle, Justin Geoghegan, Peter A. Banks, Timothy B. Gardner, Anikó Nóra Szabó, Tyler Stevens, Tamás Tornai, Emese Tóth, Gerry McEntee, de-Madaria Enrique de-Madaria, Pramod K. Garg, Péter Hegyi, Dhiraj Yadav, Weiming Hu, John Neoptolemos, Vikesh K. Singh

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Mortality in infected pancreatic necrosis (IPN) is dynamic over the course of the disease, with type and timing of interventions as well as persistent organ failure being key determinants. The timing of infection onset and how it pertains to mortality is not well defined. Objectives: To determine the association between mortality and the development of early IPN. Methods: International multicenter retrospective cohort study of patients with IPN, confirmed by a positive microbial culture from (peri) pancreatic collections. The association between timing of infection onset, timing of interventions and mortality were assessed using Cox regression analyses. Results: A total of 743 patients from 19 centers across 3 continents with culture-confirmed IPN from 2000 to 2016 were evaluated, mortality rate was 20.9% (155/734). Early infection was associated with a higher mortality, when early infection occurred within the first 4 weeks from presentation with acute pancreatitis. After adjusting for comorbidity, advanced age, organ failure, enteral nutrition and parenteral nutrition, early infection (≤4 weeks) and early open surgery (≤4 weeks) were associated with increased mortality [HR: 2.45 (95% CI: 1.63–3.67), p < 0.001 and HR: 4.88 (95% CI: 1.70–13.98), p = 0.003, respectively]. There was no association between late open surgery, early or late minimally invasive surgery, early or late percutaneous drainage with mortality (p > 0.05). Conclusion: Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.

Original languageEnglish (US)
Pages (from-to)67-73
Number of pages7
JournalPancreatology
Volume22
Issue number1
DOIs
StatePublished - Jan 2022
Externally publishedYes

Keywords

  • Infected pancreatic necrosis
  • Minimally invasive surgery
  • Mortality
  • Necrosectomy
  • Necrotizing pancreatitis
  • Pancreatic necrosis
  • Surgery

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Hepatology

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