Classification and treatment of local septic complications in acute pancreatitis
Background: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the app...
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| Veröffentlicht in: | The American journal of surgery 1995-07, Vol.170 (1), p.44-50 |
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| creator | Howard, Thomas J. Wiebke, Eric A. Mogavero, Geraldine Kopecky, Kenyon Baer, Joseph C. Sherman, Stuart Hawes, Robert H. Lehman, Glen A. Goulet, Robert J. Madura, James A. |
| description | Background: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis.
Patients and methods: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission. Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed.
Results: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score >15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days,
P = 0.02), required necrosectomy with drainage (65% versus 4%,
P |
| doi_str_mv | 10.1016/S0002-9610(99)80250-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_77353961</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002961099802505</els_id><sourcerecordid>77353961</sourcerecordid><originalsourceid>FETCH-LOGICAL-c417t-d32ab71629ac44af43f52b6e9e6a0a46469ff56775668839fddb91e6a60566673</originalsourceid><addsrcrecordid>eNqFkE1r3DAQhkVpSbdpf0LAkBLag1N9yzqFsKRtIJBA27PQyiNQsC1HkgP999FmzR566UmM5nmHmQehM4IvCSby2y-MMW21JPiL1l87TAVuxRu0IZ3SLek69hZtjsh79CHnx1oSwtkJOlFKM67ZBj1sB5tz8MHZEuLU2KlvSgJbRphKE30zRGeHJsNcgmtcHOdhRXMTKu6WAs1sJ7fPhBLyR_TO2yHDp_U9RX--3_ze_mzv7n_cbq_vWseJKm3PqN0pIqm2jnPrOfOC7iRokBZbLrnU3guplJCy3qJ93-80qU2J649U7BRdHObOKT4tkIsZQ3YwDHaCuGSjFBOsnl7B83_Ax7ikqe5maMcVF5QSXSlxoFyKOSfwZk5htOmvIdjsfZtX32Yv02htXn0bUXNn6_RlN0J_TK2Ca__z2re5ivSpqgr5iDHRdaSjFbs6YFCVPQdIJrsAk4M-JHDF9DH8Z5EXxmSbeQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2847452219</pqid></control><display><type>article</type><title>Classification and treatment of local septic complications in acute pancreatitis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Howard, Thomas J. ; Wiebke, Eric A. ; Mogavero, Geraldine ; Kopecky, Kenyon ; Baer, Joseph C. ; Sherman, Stuart ; Hawes, Robert H. ; Lehman, Glen A. ; Goulet, Robert J. ; Madura, James A.</creator><creatorcontrib>Howard, Thomas J. ; Wiebke, Eric A. ; Mogavero, Geraldine ; Kopecky, Kenyon ; Baer, Joseph C. ; Sherman, Stuart ; Hawes, Robert H. ; Lehman, Glen A. ; Goulet, Robert J. ; Madura, James A.</creatorcontrib><description>Background: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis.
Patients and methods: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission. Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed.
Results: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score >15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days,
P = 0.02), required necrosectomy with drainage (65% versus 4%,
P <0.001) rather than simple drainage (3% versus 86%,
P <0.001), more reoperations (2.3 versus 1.1,
P <0.05), and had a significantly higher mortality rate (35% versus 4%,
P <0.05). In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusions than elther patients with SN or PA (
P <0.05).
Conclusions: We conclude that this classification system allows for the stratification of patients into three distinct groups—infected necrosis, sterile necrosis, and pancreatic abscess— and has both therapeutic and prognostic usefulness.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/S0002-9610(99)80250-5</identifier><identifier>PMID: 7793493</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Abscess ; Abscesses ; Acute Disease ; Adult ; Bacteriology ; Biological and medical sciences ; Blood transfusion ; Classification ; Complications ; Computed tomography ; Demography ; Etiology ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Morbidity ; Mortality ; Necrosis ; Other diseases. Semiology ; Pancreas ; Pancreatitis ; Pancreatitis - classification ; Pancreatitis - complications ; Pancreatitis - pathology ; Pancreatitis - surgery ; Patients ; Prognosis ; Retrospective Studies ; Sepsis - classification ; Sepsis - etiology ; Sepsis - therapy ; Severity of Illness Index ; Surgical drains ; Ventilators ; Wound drainage</subject><ispartof>The American journal of surgery, 1995-07, Vol.170 (1), p.44-50</ispartof><rights>1995</rights><rights>1995 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jul 1995</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-d32ab71629ac44af43f52b6e9e6a0a46469ff56775668839fddb91e6a60566673</citedby><cites>FETCH-LOGICAL-c417t-d32ab71629ac44af43f52b6e9e6a0a46469ff56775668839fddb91e6a60566673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961099802505$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3588182$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7793493$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Howard, Thomas J.</creatorcontrib><creatorcontrib>Wiebke, Eric A.</creatorcontrib><creatorcontrib>Mogavero, Geraldine</creatorcontrib><creatorcontrib>Kopecky, Kenyon</creatorcontrib><creatorcontrib>Baer, Joseph C.</creatorcontrib><creatorcontrib>Sherman, Stuart</creatorcontrib><creatorcontrib>Hawes, Robert H.</creatorcontrib><creatorcontrib>Lehman, Glen A.</creatorcontrib><creatorcontrib>Goulet, Robert J.</creatorcontrib><creatorcontrib>Madura, James A.</creatorcontrib><title>Classification and treatment of local septic complications in acute pancreatitis</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Background: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis.
Patients and methods: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission. Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed.
Results: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score >15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days,
P = 0.02), required necrosectomy with drainage (65% versus 4%,
P <0.001) rather than simple drainage (3% versus 86%,
P <0.001), more reoperations (2.3 versus 1.1,
P <0.05), and had a significantly higher mortality rate (35% versus 4%,
P <0.05). In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusions than elther patients with SN or PA (
P <0.05).
Conclusions: We conclude that this classification system allows for the stratification of patients into three distinct groups—infected necrosis, sterile necrosis, and pancreatic abscess— and has both therapeutic and prognostic usefulness.</description><subject>Abscess</subject><subject>Abscesses</subject><subject>Acute Disease</subject><subject>Adult</subject><subject>Bacteriology</subject><subject>Biological and medical sciences</subject><subject>Blood transfusion</subject><subject>Classification</subject><subject>Complications</subject><subject>Computed tomography</subject><subject>Demography</subject><subject>Etiology</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Necrosis</subject><subject>Other diseases. Semiology</subject><subject>Pancreas</subject><subject>Pancreatitis</subject><subject>Pancreatitis - classification</subject><subject>Pancreatitis - complications</subject><subject>Pancreatitis - pathology</subject><subject>Pancreatitis - surgery</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Sepsis - classification</subject><subject>Sepsis - etiology</subject><subject>Sepsis - therapy</subject><subject>Severity of Illness Index</subject><subject>Surgical drains</subject><subject>Ventilators</subject><subject>Wound drainage</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkE1r3DAQhkVpSbdpf0LAkBLag1N9yzqFsKRtIJBA27PQyiNQsC1HkgP999FmzR566UmM5nmHmQehM4IvCSby2y-MMW21JPiL1l87TAVuxRu0IZ3SLek69hZtjsh79CHnx1oSwtkJOlFKM67ZBj1sB5tz8MHZEuLU2KlvSgJbRphKE30zRGeHJsNcgmtcHOdhRXMTKu6WAs1sJ7fPhBLyR_TO2yHDp_U9RX--3_ze_mzv7n_cbq_vWseJKm3PqN0pIqm2jnPrOfOC7iRokBZbLrnU3guplJCy3qJ93-80qU2J649U7BRdHObOKT4tkIsZQ3YwDHaCuGSjFBOsnl7B83_Ax7ikqe5maMcVF5QSXSlxoFyKOSfwZk5htOmvIdjsfZtX32Yv02htXn0bUXNn6_RlN0J_TK2Ca__z2re5ivSpqgr5iDHRdaSjFbs6YFCVPQdIJrsAk4M-JHDF9DH8Z5EXxmSbeQ</recordid><startdate>19950701</startdate><enddate>19950701</enddate><creator>Howard, Thomas J.</creator><creator>Wiebke, Eric A.</creator><creator>Mogavero, Geraldine</creator><creator>Kopecky, Kenyon</creator><creator>Baer, Joseph C.</creator><creator>Sherman, Stuart</creator><creator>Hawes, Robert H.</creator><creator>Lehman, Glen A.</creator><creator>Goulet, Robert J.</creator><creator>Madura, James A.</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>19950701</creationdate><title>Classification and treatment of local septic complications in acute pancreatitis</title><author>Howard, Thomas J. ; Wiebke, Eric A. ; Mogavero, Geraldine ; Kopecky, Kenyon ; Baer, Joseph C. ; Sherman, Stuart ; Hawes, Robert H. ; Lehman, Glen A. ; Goulet, Robert J. ; Madura, James A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-d32ab71629ac44af43f52b6e9e6a0a46469ff56775668839fddb91e6a60566673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Abscess</topic><topic>Abscesses</topic><topic>Acute Disease</topic><topic>Adult</topic><topic>Bacteriology</topic><topic>Biological and medical sciences</topic><topic>Blood transfusion</topic><topic>Classification</topic><topic>Complications</topic><topic>Computed tomography</topic><topic>Demography</topic><topic>Etiology</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Necrosis</topic><topic>Other diseases. Semiology</topic><topic>Pancreas</topic><topic>Pancreatitis</topic><topic>Pancreatitis - classification</topic><topic>Pancreatitis - complications</topic><topic>Pancreatitis - pathology</topic><topic>Pancreatitis - surgery</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Sepsis - classification</topic><topic>Sepsis - etiology</topic><topic>Sepsis - therapy</topic><topic>Severity of Illness Index</topic><topic>Surgical drains</topic><topic>Ventilators</topic><topic>Wound drainage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Howard, Thomas J.</creatorcontrib><creatorcontrib>Wiebke, Eric A.</creatorcontrib><creatorcontrib>Mogavero, Geraldine</creatorcontrib><creatorcontrib>Kopecky, Kenyon</creatorcontrib><creatorcontrib>Baer, Joseph C.</creatorcontrib><creatorcontrib>Sherman, Stuart</creatorcontrib><creatorcontrib>Hawes, Robert H.</creatorcontrib><creatorcontrib>Lehman, Glen A.</creatorcontrib><creatorcontrib>Goulet, Robert J.</creatorcontrib><creatorcontrib>Madura, James A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Howard, Thomas J.</au><au>Wiebke, Eric A.</au><au>Mogavero, Geraldine</au><au>Kopecky, Kenyon</au><au>Baer, Joseph C.</au><au>Sherman, Stuart</au><au>Hawes, Robert H.</au><au>Lehman, Glen A.</au><au>Goulet, Robert J.</au><au>Madura, James A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Classification and treatment of local septic complications in acute pancreatitis</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>1995-07-01</date><risdate>1995</risdate><volume>170</volume><issue>1</issue><spage>44</spage><epage>50</epage><pages>44-50</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Background: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis.
Patients and methods: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission. Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed.
Results: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score >15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days,
P = 0.02), required necrosectomy with drainage (65% versus 4%,
P <0.001) rather than simple drainage (3% versus 86%,
P <0.001), more reoperations (2.3 versus 1.1,
P <0.05), and had a significantly higher mortality rate (35% versus 4%,
P <0.05). In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusions than elther patients with SN or PA (
P <0.05).
Conclusions: We conclude that this classification system allows for the stratification of patients into three distinct groups—infected necrosis, sterile necrosis, and pancreatic abscess— and has both therapeutic and prognostic usefulness.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>7793493</pmid><doi>10.1016/S0002-9610(99)80250-5</doi><tpages>7</tpages></addata></record> |
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| ispartof | The American journal of surgery, 1995-07, Vol.170 (1), p.44-50 |
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| subjects | Abscess Abscesses Acute Disease Adult Bacteriology Biological and medical sciences Blood transfusion Classification Complications Computed tomography Demography Etiology Female Gastroenterology. Liver. Pancreas. Abdomen Humans Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Morbidity Mortality Necrosis Other diseases. Semiology Pancreas Pancreatitis Pancreatitis - classification Pancreatitis - complications Pancreatitis - pathology Pancreatitis - surgery Patients Prognosis Retrospective Studies Sepsis - classification Sepsis - etiology Sepsis - therapy Severity of Illness Index Surgical drains Ventilators Wound drainage |
| title | Classification and treatment of local septic complications in acute pancreatitis |
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