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Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis

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@article{9ce015783a3d43f48e779b80c050bf59,
title = "Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis",
abstract = "OBJECTIVES: To assess the influence of infection on mortality in necrotizing pancreatitis.METHODS: Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed with subgroup, sensitivity, and meta-regression analyses to evaluate sources of heterogeneity.RESULTS: We included 71 studies (n = 6970 patients). Thirty-seven (52%) studies used a prospective design and 25 scored ≥5 points on the NOS suggesting a low risk of bias. Forty studies were descriptive and 31 studies evaluated invasive interventions. In total, 801 of 2842 patients (28%) with infected necroses and 537 of 4128 patients (13%) with sterile necroses died with an odds ratio [OR] of 2.57 (95% confidence interval [CI], 2.00-3.31) based on all studies and 2.02 (95%CI, 1.61-2.53) in the studies with the lowest bias risk. The OR for prospective studies was 2.96 (95%CI, 2.51-3.50). In sensitivity analyses excluding studies evaluating invasive interventions, the OR was 3.30 (95%CI, 2.81-3.88). Patients with infected necrosis and organ failure had a mortality of 35.2% while concomitant sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%.CONCLUSIONS: Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure and infected necrosis increase mortality in necrotizing pancreatitis.",
author = "Mikkel Werge and Srdan Novovic and Schmidt, {Palle N} and Gluud, {Lise L}",
note = "Copyright {\textcopyright} 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.",
year = "2016",
month = jul,
day = "9",
doi = "10.1016/j.pan.2016.07.004",
language = "English",
volume = "16",
pages = "698--707",
journal = "Pancreatology",
issn = "1424-3903",
publisher = "S./Karger AG",
number = "5",

}

RIS

TY - JOUR

T1 - Infection increases mortality in necrotizing pancreatitis

T2 - A systematic review and meta-analysis

AU - Werge, Mikkel

AU - Novovic, Srdan

AU - Schmidt, Palle N

AU - Gluud, Lise L

N1 - Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

PY - 2016/7/9

Y1 - 2016/7/9

N2 - OBJECTIVES: To assess the influence of infection on mortality in necrotizing pancreatitis.METHODS: Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed with subgroup, sensitivity, and meta-regression analyses to evaluate sources of heterogeneity.RESULTS: We included 71 studies (n = 6970 patients). Thirty-seven (52%) studies used a prospective design and 25 scored ≥5 points on the NOS suggesting a low risk of bias. Forty studies were descriptive and 31 studies evaluated invasive interventions. In total, 801 of 2842 patients (28%) with infected necroses and 537 of 4128 patients (13%) with sterile necroses died with an odds ratio [OR] of 2.57 (95% confidence interval [CI], 2.00-3.31) based on all studies and 2.02 (95%CI, 1.61-2.53) in the studies with the lowest bias risk. The OR for prospective studies was 2.96 (95%CI, 2.51-3.50). In sensitivity analyses excluding studies evaluating invasive interventions, the OR was 3.30 (95%CI, 2.81-3.88). Patients with infected necrosis and organ failure had a mortality of 35.2% while concomitant sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%.CONCLUSIONS: Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure and infected necrosis increase mortality in necrotizing pancreatitis.

AB - OBJECTIVES: To assess the influence of infection on mortality in necrotizing pancreatitis.METHODS: Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed with subgroup, sensitivity, and meta-regression analyses to evaluate sources of heterogeneity.RESULTS: We included 71 studies (n = 6970 patients). Thirty-seven (52%) studies used a prospective design and 25 scored ≥5 points on the NOS suggesting a low risk of bias. Forty studies were descriptive and 31 studies evaluated invasive interventions. In total, 801 of 2842 patients (28%) with infected necroses and 537 of 4128 patients (13%) with sterile necroses died with an odds ratio [OR] of 2.57 (95% confidence interval [CI], 2.00-3.31) based on all studies and 2.02 (95%CI, 1.61-2.53) in the studies with the lowest bias risk. The OR for prospective studies was 2.96 (95%CI, 2.51-3.50). In sensitivity analyses excluding studies evaluating invasive interventions, the OR was 3.30 (95%CI, 2.81-3.88). Patients with infected necrosis and organ failure had a mortality of 35.2% while concomitant sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%.CONCLUSIONS: Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure and infected necrosis increase mortality in necrotizing pancreatitis.

U2 - 10.1016/j.pan.2016.07.004

DO - 10.1016/j.pan.2016.07.004

M3 - Review

C2 - 27449605

VL - 16

SP - 698

EP - 707

JO - Pancreatology

JF - Pancreatology

SN - 1424-3903

IS - 5

ER -

ID: 48378143