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

TY - JOUR

T1 - Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis

AU - Dombernowsky, Tilde

AU - Kristensen, Marlene Østermark

AU - Rysgaard, Sisse

AU - Gluud, Lise Lotte

AU - Novovic, Srdan

N1 - Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Female

KW - Heart Failure

KW - Hospital Mortality

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Pancreatitis

KW - Renal Insufficiency

KW - Respiratory Insufficiency

KW - Retrospective Studies

KW - Risk Factors

KW - Smoking

KW - Survival Analysis

KW - Young Adult

KW - Journal Article

U2 - 10.1016/j.pan.2016.06.664

DO - 10.1016/j.pan.2016.06.664

M3 - Journal article

C2 - 27424478

SN - 1424-3903

VL - 16

SP - 756

EP - 760

JO - Pancreatology

JF - Pancreatology

IS - 5

ER -