Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

Abstract

Intensive care unit; Mortality; Pancreatic infection

Unitat de cures intensives; Mortalitat; Infecció pancreàtica

Unidad de cuidados intensivos; Mortalidad; Infección pancreática

Background The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality. Methods This was a secondary analysis of an international observational study (“AbSeS”) investigating ICU patients with intra-abdominal infection. Only patients with pancreatic infection were included in this analysis (n=165). Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU. Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio (OR) and 95% confidence interval (CI). Results The overall mortality was 35.2% (n=58). The independent risk factors for mortality included older age (OR=1.03, 95% CI: 1.0 to 1.1 P=0.023), localized peritonitis (OR=4.4, 95% CI: 1.4 to 13.9 P=0.011), and persistent signs of inflammation at day 7 (OR=9.5, 95% CI: 3.8 to 23.9, P<0.001) or after the implementation of additional source control interventions within the first week (OR=4.0, 95% CI: 1.3 to 12.2, P=0.013). Gram-negative bacteria were most frequently isolated (n=58, 49.2%) without clinically relevant differences in microbial etiology between survivors and non-survivors. Conclusions In pancreatic infection, a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome. In this limited series, essentials of the AbSeS-classification, such as the setting of infection onset, diffuse peritonitis, and severity of disease expression, were not associated with an increased mortality risk. ClinicalTrials.gov number: NCT03270345

AbSeS is a Trials Group Study of the European Society of Intensive Care Medicine and was supported by a Pfizer investigator-initiated research grant. Received grants related to the submitted work: S. Blot (Pfizer). Received honoraria or grants outside the submitted work: M. Antonelli (Fresenius, Pfizer, Toray); J. De Waele (Research Foundation Flanders, Pfizer, Bayer, MSD); C. Eckmann (Merck, Pfizer); J. Lipman (MSD, Pfizer); E. Maseda (Astellas Pharma, Pfizer, MSD).