Baldursdottir Maria B, Andresson Johannes A, Jonsdottir Sigrun, Benediktsson Halldor, Kalaitzakis Evangelos, Bjornsson Einar S
Department of Internal Medicine, Landspitali University Hospital.
Faculty of Medicine, University of Iceland.
J Clin Gastroenterol. 2023 Jan 1;57(1):97-102. doi: 10.1097/MCG.0000000000001651.
Ischemic pancreatitis (IP) has mainly been described in case reports. The aims of the study were to assess the frequency, clinical characteristics and outcomes in patients with IP among patients hospitalized in the intensive care unit (ICU) for acute pancreatitis (AP).
All patients with first time AP between 2011 and 2018 in the ICU of Landspitali Hospital, Iceland were retrospectively included. IP as an etiology required a clinical setting of circulatory shock, arterial hypotension, hypovolemia and/or arterial hypoxemia [PaO 2 of 60 mm Hg (8.0 kPa), or less] before the diagnosis of AP without prior history of abdominal pain to this episode. Other causes of AP were ruled out. IP patients were compared with patients with AP of other etiologies, also hospitalized in the ICU.
Overall 67 patients with AP were identified (median age 60 y, 37% females), 31% idiopathic, 24% alcoholic, 22% IP, 15% biliary, and 8% other causes. Overall, 15 (22%) fulfilled the predetermined criteria for IP, 9 males (64%), median age 62 years (interquartile range: 46 to 65). IP was preceded mainly by systemic shock (73%). Other causes included dehydration, hypoxia, or vessel occlusion to the pancreas. Necrosis of the pancreas was rare with one patient requiring pancreatic necrosectomy. Inpatient mortality was higher among patients with IP than in other patients with AP (33% vs. 14%, P =0.12).
IP was found in a significant proportion of AP patients hospitalized in the ICU. The main causes of IP were systemic shock and hypoxia. IP was associated with ∼30% mortality.
缺血性胰腺炎（IP）主要在病例报告中有所描述。本研究的目的是评估在因急性胰腺炎（AP）入住重症监护病房（ICU）的患者中，IP患者的发生率、临床特征及预后情况。
回顾性纳入2011年至2018年期间在冰岛Landspitali医院ICU首次发生AP的所有患者。IP作为病因需要在AP诊断前出现循环性休克、动脉低血压、血容量不足和/或动脉低氧血症[动脉血氧分压（PaO₂）≤60 mmHg（8.0 kPa）]的临床情况，且此次发作无前驱腹痛病史。排除AP的其他病因。将IP患者与同样入住ICU的其他病因的AP患者进行比较。
共确定67例AP患者（中位年龄60岁，37%为女性），31%为特发性，24%为酒精性，22%为IP，15%为胆源性，8%为其他病因。总体而言，15例（22%）符合IP的预定标准，9例为男性（64%），中位年龄62岁（四分位间距：46至65岁）。IP主要由全身休克（73%）引起。其他病因包括脱水、缺氧或胰腺血管阻塞。胰腺坏死罕见，1例患者需要进行胰腺坏死组织清除术。IP患者的住院死亡率高于其他AP患者（33%对14%，P = 0.12）。
在入住ICU的AP患者中，相当一部分为IP患者。IP的主要病因是全身休克和缺氧。IP的死亡率约为30%。
