Back to Annual Meeting Posters

Introduction: Severe acute pancreatitis (SAP) is best supported in high dependency or intensive therapy units (HDU or ITU) setting and associated with high mortality and morbidity despite best efforts at attaining early diagnosis and timely intervention.
Aim: To study management and disease-related mortality of patients admitted to ITU with SAP with specific emphasis on the group that succumbed to the disease in an attempt to understand the circumstances that lead to this event and identify interventions that may have abrogated this eventuality and indicators that may have predicted the fate of these patients.
Methods: Retrospective case per case detailed analysis of management and outcome of consecutive patients admitted to ITU with SAP during the period of 2007-2010. Medical records were reviewed by a single abstractor (OJ) for patient characteristics and disease severity scoring. The development of necrosis, infected necrosis (IN) or organ failure (OF) was recorded. Patients were classified into group I (No necrosis, No OF), group II (sterile necrosis or transient OF), group III (IN or persistent OF) and group IV (infected necrosis and persistent OF). The hospital course of the four groups were studied in relation to fluid resuscitation, use and type of prophylactic or therapeutic, use of prophylactic anti-fungal, early introduction of enteral feeding, radiological/surgical intervention and any post-intervention complications.
Results:
51 patients admitted to ITU with SAP (APACHE II >8, modified Glasgow score> 3) during the period of 2007-2010. All cases fulfilled the Atlanta criteria of SAP. Median age: 66 ± 17.5. SAP was alcohol induced in 12% and due to gallstones in 59% of patients. No cause was identified in 25% of patients. Median hospital stay and ITU stay were 14 and 3.23 days respectively. Forty one patients (80%) received antibiotics and thirty five patients (69%) had nutrition support but neither of them seems to have a significant impact on survival (p = 0.6 and 0.06 respectively). The overall mortality rate during the study period (3 years) was 38% (n-19) above national average of 30%. All 7 patients in group IV died; 5 had necrosectomy and 1 had CT guided drainage of infected acute fluid collection.
Outcome (death) was statistically correlated with organ dysfunction criteria (Atlanta criteria and APACHE II score).
Conclusion: While the presence of 'IN or persistent OF' in SAP (group III) is associated with high mortality, the combination of 'IN and persistent OF' (group IV) is uniformly fatal. Further research is necessary to confirm findings in our study and to explore ways of optimising patients in group III to improve survival.

Group	Total Number	Mortality	% Mortality
I (No N & No OF)	12	0/12	0%
II (SN or Transient OF)	2	0/2	0%
III (IN or Persistent OF)	30	12/30	40%
IV (IN & Persistent OF)	7	7/7	100%