Revista Colombiana de Cirugía
versão impressa ISSN 2011-7582
ORDONEZ DELGADO, Carlos Alberto et al. Infected necrotizing pancreatitis: results in a low mortality cohort. rev. colomb. cir. [online]. 2006, vol.21, n.4, pp. 240-248. ISSN 2011-7582.
Objective: To analyze prognostic factors in patients with severe acute pancreatitis. Methods: Retrospective cohort of 64 consecutive patients with the diagnosis of severe acute pancreatitis defined as APACHE II > 8 or Ranson > 3 seen at Fundación Valle del Lili, Cali, Colombia, in the period 1995-2004. Demographic, clinical and surgical data were analyzed. Results: In the series of 64 patients, the most common etiology was cholelithiasis (51.6%). The median APACHE II score was 13. Average stay in the ICU was 16 ± 14.8 days (rank 1-63), total hospital stay was 28.1 ± 19.8 days (1-84); 82.8 % of patients were operated on, with an average number of repeat laparotomies of 4.2 ± 4.4 (1-18); 81.3% developed necrosis, infected or abscess = 84.9%, and sterile = 26.4%, with 81.3% of patients receiving antibiotics during 14 days. Positive cultures from abdomen were found in 60.9%, with Enterococcus fecalis and Staphylococcus aureus being the most commonly encountered organisms. The global mortality rate was 21.5% and the mortality rate in severe acute infected necrotizing pancreatitis was 28.9%. Factors associated with mortality were: ARDS (5.98%, IC 95% 1.3-31, p<0.02), shock (24, 2.8-671, p=0.002), and APACHE II > 20 (16.2, 3.2-37.9, p<0.0007), all of them statistically significant. No association was found with the presence of fistulae, infection, necrosis, use of antibiotics, or surgical interventions. The logistic regression analysis demonstrated that shock and APACHE II > 20 were predictors of death (OR: 31.25, 2.7-345, and OR: 1,27, 1.07-1.51, respectively, p <0.05). Conclusion: The presence of shock and the APACHE II score appeared as independent predictive factors of death. Global mortality and mortality of severe acute infected necrotizing pancreatitis were low: 21.5% and 28.9% respectively.
Palavras-chave : acute necrotizing pancreatitis; prognosis; APACHE; mortality.