Abstracts
2000 Digestive Disease Week

# 2311 Mortality from Necrotizing Pancreatitis: Which Patients Die Today?
Christophe A. Mueller, Beat Gloor, Waldemar Uhl, Mathias Worni, Stefan W. Schmid, Markus W. Buechler, Bern, Switzerland

Background: Mortality due to severe necrotizing pancreatitis (NP) most often results from multi-organ dysfunction syndrome (MODS) either occurring early within the first 10 days or late (> two weeks) due to septic complications. The aim of this study was to identify the factors that are correlated with a negative outcome. Methods: Between 11/93 and 11/99 data of 99 consecutive patients with severe NP were prospectively entered into a database. Patients were treated on intermediate or intensive care unit (ICU) as soon as the severity scoring (Ranson score >3, CRP >150mg/l) indicated a severe course of the disease or if contrast-enhanced computed tomography (CT) revealed NP. All patients received a prophylactic antibiotic therapy with imipenem/ cilastatin (14 days). Pre-existing morbidity, CT and bacteriological findings and outcome were analyzed. Statistics: Chi-square or Mann-Whitney U-test where appropriate. Results: Overall mortality was 9% (9/99). Patients died after a mean of 94 days (range 15 to 209 days). 5 deaths occurred due to septic MODS, three of them being infected with Candida. Proteus (n=1), Methicillin-resistant Staphylococcus aureus (n=1) and Pseudomonas (n=1) were additionally cultured in these 5 patients. Two patients died due to cardiac insufficiency on day 136 and 169, respectively, the latter after having recovered from infection with Methicillin-resistant Staph. aureus. One patient died from septic pulmonary emboli without apparent clinical signs of sepsis. The ninth patient succumbed severe acute respiratory distress syndrome. Pre-existing pulmonary and/or cardiac co-morbidity was more frequently diagnosed in patients with a negative outcome (5/9) as compared with survivors (16/90; p=0.02). Also, patients dying from NP had a higher mean body mass index (35.3 ± 7.2 versus 25.6 ± 6.3; p<0.01) and showed more extensive (>50%) necrosis (8/9 versus 28/90; p<0.005). There was no difference in age and biliary or alcohol etiology between the two groups. Conclusions: Early intensive care treatment including routine antibiotic treatment reduced the number of early deaths. Patients with extended infected necrosis with pre-existing cardio-pulmonary co-morbidity are most at risk for a fatal outcome.