Acute pancreatitis - severity classification, complications and outcome

Sammanfattning: Acute pancreatitis, with an annual incidence of approximately 35 per 100 000 inhabitants in Sweden, is in most cases mild and self-limiting. Severe acute pancreatitis, affecting 10-15% of the cases is, however, associated with severe complications and even death. The optimal management of acute pancreatitis includes accurate early prediction of the disease severity. The aims of this thesis were to investigate early severity classification, complications and outcome in acute pancreatitis patients, with special regard to patients developing the severe form of the disease. The results of the studies were: I) Two early risk factors for death were identified: increasing age and hypotension at admission. Deaths were to a high extent related to multiple organ dysfunction. Early recurrence after biliary acute pancreatitis was common. II) A model for early prediction of severity in acute pancreatitis with artificial neural networks was developed, identifying 6 risk factors. The ROC area for the model was 0.92, and it performed significantly better than the APACHE II score. III) Patients with pancreatic pseudocysts were found to be resource demanding in regard to recurrences and repeated hospital visits. Even larger pancreatic pseudocysts could be managed successfully with conservative treatment. IV) In a national Swedish survey, the treatment of patients with pancreatic pseudocysts appeared to be heterogeneous, with different treatment options available and varying local traditions. V) In long-term follow-up after acute pancreatitis, impairment was mainly seen in the endocrine pancreatic function, and especially after severe disease. The time to rehabilitation and return to work and normal life was long, and the costs for the society high. The quality of life years after the disease was, however, as good as in the normal population. VI) A survey of patients dying in acute pancreatitis without reaching the hospital showed that this group represents a substantial part of all deaths from the disease. The dominating aetiology was alcohol. Pulmonary injury was the most common organ manifestation outside the pancreas. To reduce mortality due to acute pancreatitis it is important to target also the patients that never reach hospital.