• Qiang Guo, Ang Li, Qing Xia, Xubao Liu, Bole Tian, Gang Mai, Zongwen Huang, Guangyuan Chen, Wenfu Tang, Xiaodong Jin, Weixia Chen, Huimin Lu, Nengwen Ke, Zhaoda Zhang, and Weiming Hu.
• *Hepato-Bilio-Pancreatic Surgery †Department of Integrated Traditional Chinese and Western Medicine ‡Intensive Care Unit §Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
• Ann. Surg.. 2014 Jun 1;259(6):1201-7.

ObjectiveTo clarify the roles of organ failure and infection in the outcome of necrotizing pancreatitis.BackgroundResults of previous cohort studies that focused on the roles of infection and organ failure in acute pancreatitis are controversial.MethodsIn this study, we collected the medical records of 447 patients with necrotizing pancreatitis from January 2009 to June 2012. Data associated with organ failure and infection were analyzed.ResultsThe overall mortality rate was 13% (58/447). Intervention was performed in 223 of 447 patients. Among these 223 patients, 134 were confirmed to be with infected necrosis by a positive culture. The mortality rate was 15% (13/89) in the sterile necrosis group and 18% (24/134) in the infected necrosis group (P = 0.52). A multivariate analysis of death predictors indicated that bacteremia (odds ratio [OR] = 2.76, 95% confidence interval [CI], 1.23-5.46, P < 0.001), age (OR = 1.07, 95% CI, 1.03-1.11, P < 0.001), American Society of Anesthesiologists class (OR = 3.56, 95% CI, 1.65-7.18, P = 0.001), persistent organ failure in the first week (OR = 16.72, 95% CI, 7.04-32.56, P < 0.001), and pancreatic necrosis (OR = 1.73, 95% CI, 1.14-2.98, P = 0.008) were significant factors.ConclusionsAmong patients with necrotizing pancreatitis, the effects of organ failure on mortality are more critical than those of infection. Bacteremia, age, American Society of Anesthesiologists class, persistent organ failure in the first week, and pancreatic necrosis were identified as the predictors of mortality.

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