Extra-pancreatic complications,especially hemodialysis predict mortality and length of stay,in ICU patients admitted with acute pancreatitis

Background and aims:Patients in the intensive care unit(ICU)with acute pancreatitis(AP)are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay.We sought to determine the rate of extra-pancreatic complications and its effect on length of stay(LOS)and mortality in ICU patients with AP.Methods:We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP.A total of 287 ICU patients had a discharge diagnosis of AP,of which 163 met inclusion criteria.We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality.Results:There were a total of 158 extra-pancreatic complications(0.97 extra-pancreatic complications per patient).Ninetyfive patients had at least one extra-pancreatic complication,whereas 68 patients had no extra-pancreatic complications.Patients with extra-pancreatic complications had a significantly longer LOS(14.7 vs 8.8 days,p<0.01)when controlling for local pancreatic complications.Patients with non-infectious extra-pancreatic complications had a higher rate of mortality(24.0%vs 16.2%,p=0.04).Patients requiring dialysis was an independent predictor for LOS and mortality(incidence risk ratio[IRR]1.73,95%confidence interval[CI]:1.263–2.378 and IRR 1.50,95%CI 1.623–6.843,p<0.01)on multi-variable analysis.Coronary events were also a predictor for mortality(p=0.05).Other extra-pancreatic complications were not significant.Conclusions:Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS.Patients with noninfectious extra-pancreatic complications have a higher mortality rate.After controlling for local pancreatic complications,patients requiring dialysis remained an independent predictor for LOS and mortality.