Infection of necrosis is considered as principal determinant of outcome in necrotizing pancreatitis.
It is as potential complication after operative treatment of sterile necrosis.
Dr Bettina Rau and colleagues from Germany assessed 392 patients with necrotizing pancreatitis.
The research team stratified 135 patients with operatively treated sterile necrosis into 3 postoperative entities.
Group 1 included patients with secondary pancreatic infections, and Group 2 had patients with pancreatic contaminations.
Patients with sterile courses were included in Group 3.
Group 4 had 95 patients with conservatively treated sterile necrosis served as controls.
The investigative team found that secondary pancreatic infections developed in 47% of patients and 27% had contaminations.
| Secondary pancreatic infections developed in 47% of patients|
|Clinical Gastroenterology & Hepatology|
The team noted that 25% of patients remained sterile postoperatively.
Secondary pancreatic infections and contaminations were both diagnosed after a median of 3 weeks after disease onset.
Early/preoperative multisystem organ failure affecting 2 organs occurred in 35% of Group 1 vs 5% in Group 2, 12% in Group 3, and 7% in Group 4.
The investigators observed that mortality rates were 38%, 3%, 21%, and 7%, in the 4 groups, respectively.
Multiple logistic regression identified early/preoperative multisystem organ failure as a risk factor for secondary pancreatic infections in operatively treated sterile necrosis.
Extent of intrapancreatic necrosis was also a major risk factor to develop secondary pancreatic infections in operatively treated sterile necrosis.
However, the team observed that only early onset multisystem organ failure affecting 2 organs was the main risk factor for death.
Dr Rau's team concludes, “Early multisystem organ failure and extended intrapancreatic necrosis are risk factors for secondary pancreatic infections after operative treatment of sterile necrosis.”
“In contrast, the ultimate outcome strongly depends on early and high systemic illness, whereas local pathology and operative procedure seem to be less important.”