Outcome Prediction and Quality of Life in Severe Acute Pancreatitis

7 7 1. ABSTRACT Prognosis in severe acute pancreatitis (SAP) Background. Acute pancreatitis (AP) is a common abdominal disorder with a severity varying from mild to fatal disease. Survival of patients with AP, and particularly in severe acute pancreatitis (SAP), is related to a combination of therapy-associated and patient-related factors. Predicting an individual patient's outcome remains problematic. There are only a few relevant methods for predicting mortality among patients with acute pancreatitis. The factors which cause death in most patients with SAP seem to be related specifically to the multiple organ dysfunction (MOD) syndrome. In the early phase of SAP multiple organ failure (MOF) seems to be caused by the same cytokine and inflammatory mediators as in septic shock. There are numerous ways to define and score MOD. There are three more recent scores: the MOD score, the Sequential (former Sepsis-related) Organ Failure Assessment (SOFA) score, and the Logistic Organ Dysfunction (LOD) score. These scores are designed to assess the severity and development of MOD as a single score. With an increasing number of patients surviving SAP more attention has been directed towards quality of life and long-term outcome, especially in patients with alcohol-induced disease. In studies with a small number of patients, quality of life and outcome after SAP have been good. However, only two of these studies have used generic multidimensional measures. Aims. The first aim was to analyze a large consecutive series of patients with SAP to identify factors releted to the risk of dying during hospital treatment. Secondly, to construct a novel model to predic a fatal outcome in the early phase of SAP and to compare this model with current predictive models. Thirdly, to compare the MOD, SOFA, and LOD scores as predictors of hospital mortality, and to use one of these scores to assess the incidence and the prognostic usefulness of organ dysfunction/failure in patients with SAP treated in a general ICU. A further aim was to define the overall long-term post-discharge outcome after SAP. Patients and methods. The total number of episodes of AP in the study during the 10 years study period was 1539 of which 317 (21%) were SAP. A consecutive series of 270 patients with SAP was included to study the factors related to a fatal outcome by univariate and multivariate analyses. In addition, 234 patients with sufficient data were included to construct five logistic regression models and three artificial …