Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2017; 23(29): 5431-5437
Published online Aug 7, 2017. doi: 10.3748/wjg.v23.i29.5431
Clinical outcomes of isolated renal failure compared to other forms of organ failure in patients with severe acute pancreatitis
Amir Gougol, Mohannad Dugum, Anwar Dudekula, Phil Greer, Adam Slivka, David C Whitcomb, Dhiraj Yadav, Georgios I Papachristou
Amir Gougol, Mohannad Dugum, Anwar Dudekula, Phil Greer, Adam Slivka, David C Whitcomb, Dhiraj Yadav, Georgios I Papachristou, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States
Author contributions: Dugum M, Gougol A and Papachristou GI contributed to study concept and design, acquisition of data, statistical analysis, data interpretation, drafting of the manuscript, critical revision of the manuscript for important intellectual content; Dudekula A and Greer P contributed to statistical analysis, data interpretation; Slivka A, Whitcomb DC and Yadav D contributed to acquisition of data, critical review of manuscript for important intellectual content; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the University of Pittsburgh.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at papachri@pitt.edu. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georgios I Papachristou, MD, PhD, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, 200 Lothrop Street, UPMC Presbyterian, M2, C-Wing, Pittsburgh, PA 15213, United States. papachri@pitt.edu
Telephone: +1-412-6489241 Fax: 1-412-6489378
Received: March 22, 2017
Peer-review started: March 28, 2017
First decision: April 20, 2017
Revised: June 3, 2017
Accepted: July 4, 2017
Article in press: July 4, 2017
Published online: August 7, 2017
Abstract
AIM

To assess differences in clinical outcomes of isolated renal failure (RF) compared to other forms of organ failure (OF) in patients with severe acute pancreatitis (SAP).

METHODS

Using a prospectively maintained database of patients with acute pancreatitis admitted to a tertiary medical center between 2003 and 2016, those with evidence of persistent OF were classified to renal, respiratory, cardiovascular, or multi-organ (2 or more organs). Data regarding demographics, comorbidities, etiology of acute pancreatitis, and clinical outcomes were prospectively recorded. Differences in clinical outcomes after development of isolated RF in comparison to other forms of OF were determined using independent t and Mann-Whitney U tests for continues variables, and χ2 test for discrete variables.

RESULTS

Among 500 patients with acute pancreatitis, 111 patients developed persistent OF: mean age was 54 years, and 75 (67.6%) were male. Forty-three patients had isolated OF: 17 (15.3%) renal, 25 (21.6%) respiratory, and 1 (0.9%) patient with cardiovascular failure. No differences in demographics, etiology of acute pancreatitis, systemic inflammatory response syndrome scores, or development of pancreatic necrosis were seen between patients with isolated RF vs isolated respiratory failure. Patients with isolated RF were less likely to require nutritional support (76.5% vs 96%, P = 0.001), ICU admission (58.8% vs 100%, P = 0.001), and had shorter mean ICU stay (2.4 d vs 15.7 d, P < 0.001), compared to isolated respiratory failure. None of the patients with isolated RF or isolated respiratory failure died.

CONCLUSION

Among patients with SAP per the Revised Atlanta Classification, approximately 15% develop isolated RF. This subgroup seems to have a less protracted clinical course compared to other forms of OF. Isolated RF might be weighed less than isolated respiratory failure in risk predictive modeling of acute pancreatitis.

Keywords: Renal failure, Respiratory failure, Organ failure, Acute pancreatitis, Clinical outcomes

Core tip: In a large prospective observational study, we show that approximately 15% of patients with severe acute pancreatitis develop isolated renal failure. This subgroup has an overall better prognosis and less protracted clinical course compared to patients with other isolated or multiple organ failure. These results can be useful in allocating healthcare resources and counseling patients. We propose that isolated renal failure be weighed less in risk predictive modeling of acute pancreatitis.