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Survival and new-onset morbidity after critical care admission for acute pancreatitis in Scotland: a national electronic healthcare record linkage cohort study.

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Original languageEnglish
JournalBMJ Open
Early online date14 Dec 2018
DOIs
Publication statusE-pub ahead of print - 14 Dec 2018

Abstract

Introduction: Severe acute pancreatitis (AP) requiring critical care admission (ccAP) impacts negatively on long-term survival.
Objective: To document organ-specific new morbidity and identify risk factors associated with premature mortality after an episode of ccAP.
Design: Cohort study
Setting: Electronic healthcare registries in Scotland.
Participants: ccAP cohort: 1471 patients admitted to critical care with AP between 1st January 2008 and 31st December 2010 followed up until 31st December 2014; population cohort: 3450 individuals from the general population of Scotland frequency matched for age, sex and social deprivation.
Methods: Record linkage of routinely-collected electronic health data with population matching.
Primary and secondary outcome measures: Patient demographics, co-morbidity (Charlson Index), acute physiology, organ support and other critical care data were linked to records of mortality (death certificate data) and new-onset morbidity. Kaplan Meier and Cox regression analyses were used to identify risk factors associated with mortality.
Results: 310 patients with AP died during the index admission. Outcomes were not ascertained for 5 patients, and the deprivation quintile was not known for 6 patients. 340 of 1150 patients in the resulting post-discharge ccAP cohort died during the follow-up period. Greater co-morbidity measured by the Charlson score, prior to ccAP, negatively influenced survival in hospital and after discharge. The odds of developing new-onset diabetes mellitus after ccAP compared to the general population was 10.70 (95% C.I. 5.74 to 19.94). A new diagnosis of myocardial infarction, stroke, heart failure, liver disease, peptic ulcer, renal failure, cancer, peripheral vascular disease and lung disease was more frequent in the ccAP cohort than the general population.
Conclusions: The persistent deleterious impact of severe AP on long-term outcome and survival is multifactorial in origin, influenced by pre-existing patient characteristics and acute episode features. Further mechanistic and epidemiologic investigation is warranted.



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