Predicting need for intervention in acute necrotizing pancreatitis following discharge- A single center experience in 525 patients

Guru Trikudanathan, Ahmed Dirweesh, Nauroze Faizi, Robben Schat, Gaurav Suryavwanshi, Scott Lunos, David Jonason, Nabeel Azeem, Stuart K. Amateau, Shawn Mallery, Anil Chauhan, Martin L. Freeman

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND AIMS: The clinical course of necrotizing pancreatitis (NP) is variable and unpredictable, with some patients managed conservatively, but a significant proportion become symptomatic and needing intervention for drainage and/or necrosectomy. The aim of this study was to identify patients based on baseline clinical and imaging metrics who will likely need intervention and therefore closer follow-up.

METHODS: All NP patients managed in our institution between 2010 and 2019 were identified from a prospective database and those who did not undergo intervention during initial hospitalization were followed longitudinally post discharge until clinical and imaging resolution of necrosis. Patients were categorized into a conservative arm or intervention arm (endoscopic/percutaneous/surgical drainage and/or necrosectomy) for criteria defined according to IAP/APA guidelines. Clinical and imaging characteristics during initial presentation were analyzed between the two groups to identify independent predictors for eventual intervention using multivariable logistic regression. A nomogram was designed based on factors that were significant as defined by P value < 0.05.

RESULTS: Among 525 patients, 340 who did not meet criteria for intervention during initial admission were included for study and followed for an average 7.4 ± 11.3 months. 140 were managed conservatively and 200 needed intervention (168 within 6 months and 32 after 6 months). Independent predictors of need for eventual intervention were white race [OR 3.43 (1.11-10.62)], transferred status [OR 3.37 (1.81-6.27)], and need for TPN [OR 6.86 (1.63-28.9)], necrotic collection greater than 6 cm [OR 8.66 (4.10-18.32)] and necrotic collection with greater than 75% encapsulation [OR 41.3 (8.29-205.5)]. A prediction model incorporating these factors demonstrated an area under the curve of 0.88.

CONCLUSIONS: Majority of NP patients do not need intervention during initial admission but may require drainage/necrosectomy mostly in the first 6 months following discharge. Need for subsequent intervention can be accurately predicted by a combination of clinical and imaging features on index admission.

Original languageEnglish (US)
Pages (from-to)1063-1070
Number of pages8
JournalPancreatology
Volume22
Issue number8
DOIs
StatePublished - Dec 2022

Bibliographical note

Funding Information:
SL receives support from National Institute of Health's National Center for Advancing Translational Sciences , Grant UL1TR00249 .

Publisher Copyright:
© 2022

Keywords

  • Conservative management
  • Interventions
  • Necrosectomy
  • Necrotizing pancreatitis
  • Pancreatitis, Acute Necrotizing/diagnostic imaging
  • Aftercare
  • Drainage/methods
  • Humans
  • Patient Discharge
  • Necrosis/surgery
  • Treatment Outcome
  • Retrospective Studies

PubMed: MeSH publication types

  • Journal Article

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