Pancreatites agudas graves: Estudo retrospetivo da casuística do serviço de Medicina Intensiva da ULS São João 2018-2022

Abstract

Introduction: Severe acute pancreatitis (SAP) - pancreatitis associated with organ failure and/or local complications that lasts longer than 48h - accounts for 20-30% of acute pancreatitis and its mortality rate is approximately 15%. An early and adequate stratification of severity, with definition of those who benefit from admission in Intensive Care Medicine Services (ICMS) is decisive for the outcome. This study aims to understand the epidemiology of SAP and establish the factors associated with poor outcomes. Methods: Retrospective longitudinal observational study of patients admitted due to SAP to the ICMS of a tertiary hospital, between January 1st, 2018 and December 31st, 2022. Multiple variables related to patient, disease and treatment were studied and the chosen outcome variables were: "Death", "Number of hospitalization days" and "Number of days in the ICMS". Results: We studied 121 patients diagnosed with SAP, 1,05% of total hospitalizations in the ICMS. The median SOFA was 4, SAPS II was 32 and 96,7% of patients had a moderately severe or severe form according to the Atlanta classification, with invasive mechanical ventilation, vasopressors, renal support and parenteral nutrition used in 22, 20, 10 and 11% of patients, respectively. The median length of stay in the ICMS and in the hospital were 3 and 13 days, respectively. Hospital mortality rate was 19% (standardized mortality based on SAPS II of 1,46). The variables independently associated with length of hospital stay were: presence of pathogens in abdominal samples, use of antifungals, presence of pancreatic imaging abnormalities, use of parenteral nutrition and number of days of hospital stay pre-ICMS. Only SAPS II, pancreatic puncture/drainage and development of intra-abdominal hypertension were significantly and independently associated with hospital mortality. Conclusions: The morbi-mortality associated with SAP is high. Severity at admission in ICMS, delay in admission to ICMS, digestive dysfunction and development of infection or of intra-abdominal hypertension associated with SAP appear to be associated with a worse clinical outcome. Keywords: Pancreatitis ; Prognosis ; Intensive Care Medicine ; Epidemiology.