Acute pancreatitis and fulminant hepatic failure.
BACKGROUND
The association of acute pancreatitis with fulminant hepatic failure (FHF) was first recognized in 1973. Since then, few studies have described the clinical profile of the FHF patient with acute pancreatitis. Identification of the distinguishing attributes of pancreatitis in combination with FHF will provide a more sound basis for clinical management. The purposes of this study were to identify distinguishing clinical characteristics of acute pancreatitis in FHF and to compare outcomes with those of patients with acutely decompensated chronic liver disease and acute pancreatitis (DECOMP).


METHODS
This was a retrospective survey of 30 patients with FHF and 30 with DECOMP admitted during the period July 1995 to July 1997.


RESULTS
The prevalence of acute pancreatitis in FHF and DECOMP was 33% and 23%, respectively. Acute pancreatitis was associated with severe hepatocellular synthetic dysfunction, renal insufficiency, requirement for endotracheal intubation, increased acuity of illness at the time of ICU admission, more rapid decompensation during the disease, and significantly greater mortality in both the FHF and DECOMP groups.


CONCLUSIONS
In both FHF and DECOMP, acute pancreatitis increases disease acuity and mortality. Acute pancreatitis does not occur with significantly greater frequency in FHF. Implementation of orthotopic liver transplantation may not be warranted in this setting.
Kuo
P C
PC
Department of Surgery, University of Maryland, Baltimore, USA.
Plotkin
J S
JS
Johnson
L B
LB
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D003422:Critical Care; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal; D008099:Liver / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D015995:Prevalence; D011517:Prothrombin Time; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin