Introduction

Although the mortality rate of severe acute pancreatitis (SAP) has improved, it remains high. Especially, disseminated intravascular coagulation (DIC) can be a fatal factor. The purpose of this study was to analyze the factors associated with the mortality of SAP with DIC and to explore measures that contribute to improving the mortality rate.

Aims & Methods

We retrospectively collected data on 131 consecutive patients with SAP complicated by DIC at 9 institutions from April 2011 to March 2021. We collected data on patient background and treatment for pancreatitis (medications, enteral nutrition, tracheal intubation, and arterial injection therapy, etc.) after treatment initiation. We excluded nine patients who died within 48 hours of treatment initiation and eight patients with missing data due to hospital transfer, and analyzed the mortality rate and factors associated with mortality in 114 cases of SAP with DIC.

Results

The median DIC score at diagnosis according to the Japanese Association for Acute Medicine criteria (JAAM criteria) was 5 (4-8), there were 85 males, and the median age was 71.0 (16-93) years. The median Japanese severity score for acute pancreatitis (AP) was 2 (0-9), and the mortality rate was 11.4% (13/114). Univariate analysis identified age 70 years or older (OR 4.3), DIC secession at day 7 (OR 0.12), arterial injection therapy (OR 5.17), and walled-off necrosis (WON) complication (OR 5.38) as significant factors associated with mortality. Multivariate analysis revealed that age 70 years or older (OR 4.3 [95%CI: 1.58-11.7]), DIC secession at day 7 (OR 0.06 [0.008-0.320]), and WON complication (OR 10.1 [1.85-81.4]) were independent prognostic factors. Factors contributing to DIC secession at day 7 were the use of recombinant thrombomodulin (rTM) (OR 2.42 [1.02-5.71], 60 patients with rTM and 54 patients without rTM) and a SOFA score of 5 or less at baseline (OR 2.65 [1.13-2.65]). Factors associated with WON complication were arterial injection therapy (OR 4.37 [1.27-15.0]) and enteral nutrition administration (OR 4.66 [1.70-12.8]).

Conclusion

The mortality rate of SAP complicated by DIC was 11.4%, and over 70 years of age, WON complication, and failure to secession DIC by day 7 were associated with mortality. Because the use of rTM improves the rate of DIC secession at day 7, it may improve the mortality rate in SAP complicated by DIC.