Correlates of organ failure in severe acute pancreatitis

JOP. 2009 May 18;10(3):271-5.

Abstract

Context: The clinical course of severe acute pancreatitis may be complicated by organ failure.

Objective: We studied the incidence of organ failure and the correlation of the extent of necrosis and infective necrosis with organ failure.

Methods: The medical records of 161 patients with severe acute pancreatitis and persistent organ failure over a 4-year period were studied.

Main outcome measures: Pancreatic necrosis on CT was graded as <30%, 30-50% and >50% necrosis. Infected necrosis was diagnosed on the basis of a positive culture of fine needle aspiration or of a surgical specimen. Organ failure was defined according to the Atlanta criteria. Patient demographics, extent of pancreatic necrosis and presence of infection were correlated with organ failure.

Intervention: All patients were managed by a predefined treatment protocol.

Results: Of the 161 patients (124 males, 37 females, mean age 41.5+/-15.0 years), 52.2% had organ failure. In patients with organ failure, 48.8% had one, 33.3% two and 17.8% had multiple organ failure. Pulmonary failure was the most common organ dysfunction (76.2%). A more advanced age of patients and a higher APACHE II score were significant risk factors for the development of organ failure. Pancreatic necrosis on CT scan in patients with one, two and three organ failures was 48.8%, 51.8% and 83.3%, respectively while, in patients without organ failure, only 28.6% had more than 50% necrosis (P<0.001). No correlation was found between infected necrosis and organ failure. Overall mortality was 47.8% and mortality increased with an increasing number of organ failures.

Conclusion: Persistent organ failure occurred in 52.2% of our patients with severe acute pancreatitis. The advanced age of the patients, a higher APACHE II score and the extent of necrosis, but not infected necrosis, emerged as significant correlates of organ failure.

MeSH terms

  • APACHE
  • Acute Disease
  • Adult
  • Age Distribution
  • Biopsy, Fine-Needle
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / mortality*
  • Multiple Organ Failure / pathology*
  • Necrosis
  • Pancreatitis / mortality*
  • Pancreatitis / pathology*
  • Pancreatitis / surgery
  • Pancreatitis / therapy
  • Risk Factors
  • Severity of Illness Index*