Patients with alcohol-induced severe acute pancreatitis have a higher risk of developing intra-abdominal hypertension and systemic complications

Abstract

Introduction: Alcohol-induced severe acute pancreatitis (SAP) is frequently associated with intra-abdominal hypertension (IAH), development of abdominal compartment syndrome (ACS) and multiple organ failure. The study compares the incidence of IAH, ACS, organ failure and development of acute necrotic collections (ANC) in patients with alcohol-induced and biliary pancreatitis. Methods: SAP patients (classified according to the revised Atlanta classification) treated between 2003 and 2014, were included retrospectively and stratified into groups: alcohol-induced pancreatitis (group 1) and pancreatitis of biliary origin (group 2). The groups were compared according to the incidence of IAH, ACS and organ failure, the need for renal replacement therapy (continuous veno-venouse hemofiltration (CVVH)) and the development of the ANC. Results: Out of 175 patients, 120 had alcohol-induced SAP, and 55 patients - biliary SAP. Grade-III IAH and ACS incidence was significantly higher in group 1 (31.7% vs. 16.4%, p = 0.033; 40% vs. 20%, p = 0.009). Renal and respiratory failure was more common in group 1 (48.3% vs. 21.8%, p < 0.001; 34.2% vs. 14.5%, p = 0.007), without a difference in the cardiovascular failure incidence. The need for CVVH was higher, and the development of symptomatic large ANC was greater in group 1 (88.3% vs. 54.5%, p < 0.001; 40.8% vs. 18.2%, p = 0.003) leading to a significantly longer median ICU stay in group 1 (11 days vs. 5 days, p = 0.03). The mortality rate was similar in both groups - 12.1% and 10.2%. Conclusion: Patients with alcohol-induced SAP are at a higher risk of developing IAH, ACS and organ failure, leading to a longer ICU stay.