>Year 2011, Issue 2
Rodea-Rosas H, Valadez-Caballero D, Gutiérrez-Banda C, Sánchez-González A, Galindo-González F, Athié-Gutiérrez C
Prevalence of diabetes mellitus secondary to pancreatic necrosectomy
Cir Gen 2011; 33 (2)
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Objective: To report on the prevalence of diabetes mellitus secondary to necrosectomy due to septic complication of severe acute pancreatitis.
Setting: General Hospital of Mexico.
Design: Clinical comparative, observational, longitudinal, transversal, retrospective study.
Statistical analysis: Central tendency measures, Chi square (χ2) and Student’s t tests.
Material and methods: We evaluated all consecutive patients with a diagnosis of diabetes mellitus secondary (DMS) to a necrosectomy due to septic complication of severe acute pancreatitis (SAP) cared for between January 1st 1999 and December 31st 2009, older than 18 years, of either sex, alive at the time of follow-up, and a follow-up of 12 months. Assessed variables were: age, gender, etiology, degree of necrosis, number of pancreatic debridements, in-hospital stay days, days of Intensive Care Unit stay, scores of preoperative Ranson, APACHE II, and Balthazar, fasting glycemia at 1, 6, and 12 months after the last surgery to detect patients with DMS.
Results: From a total of 137 patients with septic complications of SAP and necrosectomy, 67 were excluded: 33 (24%) due to death, 26 (18.9%) because of incomplete follow up, and 8 (5.8%) because of DM before the acute pancreatitis event, this left 70 patients of which 46 (65.7 %) developed DMS; etiology was alcoholic in 36 (51.4%), biliary in 31 (44.3%), and other causes in 3 (4.3%). Tomography evaluation revealed 10 (14.3%) cases with Balthazar C, 20 (28.6%) with D, and 40 (57.1%) with E. Pancreatic debridements performed were: 1 in 18 patients (25.8%), 2 in 12 (17.1%), 3 in 12 (17.1%), 4 in 13 (18.6%), and 5 or more in 15 cases (21.4%). Average in-hospital stay and in the Intensive Care Unit was 21.6 (range 10-48) days and 14.2 (range 5-28) days, respectively. The average Ranson score was of 2.8 (range 2-6) and average preoperative APACHE II was of 12 (range 8-28). DMS was detected in most patients shortly after their hospital discharge; in 82.6% at 4 weeks, in 17.4% at 6 months, and none at 12 months after the last necrosectomy. CAT evidenced a higher frequency of DM in those patients classified with E (P ‹ 0.0001), as well as with more than 4 debridements, with a P ‹ 0.001.
Conclusions: Prevalence of DMS in patients with infected pancreatic necrosis, post-necrosectomy was of 65.7%, and it is related with a Balthazar E score by means of CAT, and with 4 or more debridements.
||Pancreatitis, necrosectomy, diabetes mellitus, complications.
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>Year 2011, Issue 2