Frey et al identified risk factors for multi-organ failure (MOF) and early death in patients with acute pancreatitis. These can help identify a patient who may benefit from more aggressive management. The authors are from the University of California at Davis.
Patient selection: severe acute pancreatitis
Outcomes: MOF and death within 2 weeks of hospitalization
Parameters:
(1) age of the patient in years
(2) number of comorbid conditions
Comorbid conditions:
(1) congestive heart failure (CHF)
(2) disease of cardiac valve(s)
(3) disorder of the pulmonary circulation
(4) peripheral vascular disease (PAD)
(5) hypertension
(6) paralysis
(7) other neurological disease
(8) chronic lung disease
(9) diabetes mellitus
(10) hypothyroidism
(11) renal failure
(12) liver disease
(13) chronic peptic ulcer disease
(14) morbid obesity
(15) malnutrition
(16) chronic anemia
(17) addiction (alcohol and/or drug dependency)
(18) malignant lymphoma
(19) primary cancer
(20) metastatic cancer
|
Parameter |
Finding |
OR |
|
age in years |
< 55 years |
1 |
|
|
55 to 64 |
1.4 |
|
|
65 to 75 |
2.6 |
|
|
> 75 years |
5.1 |
|
number of comorbid conditions |
none |
1 |
|
|
1 |
2.5 |
|
|
2 |
3.6 |
|
|
>= 3 |
7.4 |
cumulative odds ratio of early death =
= (odds ratio for age) * (odds ratio for number of comorbid conditions)
Interpretation:
• minimum cumulative odds ratio: 1 (associated with early mortality rate 0.1%)
• maximum cumulative odds ratio: 38
• A cumulative odds ratio of 29 was associated with a 5.9% mortality rate, so even with the maximum odds ratio the risk of early death is < 10%.
Specialty: Gastroenterology
