Volume, but Not the Location of Necrosis, Is Associated with Worse Outcomes in Acute Pancreatitis: A Prospective Study.

Background and Objectives : The course and clinical outcomes of acute pancreatitis (AP) are highly variable. Up to 20% of patients develop pancreatic necrosis. Extent and location of it might affect the clinical course and management. The aim was to determine the clinical relevance of the extent and location of pancreatic necrosis in patients with AP. Materials and Methods : A cohort of patients with necrotizing AP was collected from 2012 to 2018 at the Hospital of Lithuanian University of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (<30%, 30-50%, >50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. All contrast enhanced computed tomography (CECT) scans were evaluated by at least two experienced abdominal radiologists. All patients were treated according to the standard treatment protocol based on current international guidelines. Results : The study included 83 patients (75.9% males ( n = 63)) with a mean age of 53 ± 1.7. The volume of pancreatic necrosis exceeded 50% in half of the patients ( n = 42, 51%). Positive blood culture ( n = 14 (87.5%)), multiple organ dysfunction syndrome ( n = 17 (73.9%)) and incidences of respiratory failure ( n = 19 (73.1%)) were significantly more often diagnosed in patients with pancreatic necrosis exceeding 50% ( p < 0.05). Patients with >50% of necrosis were significantly ( p < 0.05) more often diagnosed with moderately severe ( n = 24 (41.4%)) and severe ( n = 18 (72%)) AP. The number of surgical interventions ( n = 18 (72%)) and ultrasound-guided interventions ( n = 26 (65%)) was also significantly higher. In patients with whole-pancreas necrosis, incidence of renal insufficiency ( n = 11 (64.7%)) and infected pancreatic necrosis ( n = 19 (57.6%)) was significantly higher ( p < 0.05). Conclusions : The clinical course and outcome were worse in the case of pancreatic necrosis exceeding 50%, rendering the need for longer and more complex treatment.