Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 16; no. 5; pp. 756 - 760
• Main Authors: Dombernowsky, Tilde, Kristensen, Marlene Østermark, Rysgaard, Sisse, Gluud, Lise Lotte, Novovic, Srdan
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01-09-2016; Elsevier Limited
• Subjects: Acute pancreatitis; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Body mass index; Cohort Studies; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Heart Failure - complications; Heart Failure - mortality; Hospital Mortality; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Organ failure; Pancreatitis - complications; Pancreatitis - mortality; Renal Insufficiency - complications; Renal Insufficiency - mortality; Respiratory complications; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory therapy; Retrospective Studies; Risk Factors; Smoking - adverse effects; Studies; Survival Analysis; Young Adult; Atlanta Georgia; Organ failure; Acute pancreatitis; Respiratory failure; Respiratory complications; Mortality
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2016.06.664

Abstract Background The incidence of respiratory failure and other respiratory complications in the early phase of acute pancreatitis (AP) is not well investigated. Objective To evaluate the incidence and risk factors of respiratory failure, and its impact on mortality in the early phase AP. Methods Retrospective cohort study including 359 patients admitted with acute pancreatitis. Information was gathered from electronic patient records. We defined respiratory failure based on the modified Marshall scoring system in the revised Atlanta criteria. Predictors of respiratory failure were evaluated in univariable and multivariable logistic regression analysis. Results The cohort included 188 women and 171 men with a mean age of 56.1 years. Respiratory complications including pleural effusion, pneumonia and atelectasis were registered in 80 patients (22%), 100 (29%) needed oxygen therapy, 27 (8%) continuous positive airway pressure, and six (2%) mechanical ventilation. Thirty-two patients (9%) were treated with bronchodilators and 12 (3%) with steroids. Thirty-one patients (9%) fulfilled the diagnostic criteria for respiratory failure. Five of these patients (16%) did not have effusion, atelectasis or pneumonia. Predictors of respiratory failure in multivariable analysis were age (OR 1.04; CI 95% (1.03–1.07)) and smoking (OR 2.67; CI 95% (1.21–5.86)). Thirteen patients died in hospital. The Kaplan-Meier curves and log-rank tests showed that patients with respiratory failure had increased in-hospital mortality as did patients with cardiovascular and renal failure (P < 0.01 for all analyses). Conclusions Respiratory complications are frequent in the early phase of AP. Respiratory, cardiovascular and renal failure is associated with a poor outcome. The fact that patients without effusion, atelectasis, or pneumonia may develop respiratory failure, suggests that acute lung injury, possibly associated with systemic inflammation, may be important.