Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis.
BACKGROUND
All patients with organ dysfunction are currently classified as having severe acute pancreatitis. The aim of this study was to characterize the systemic inflammatory response syndrome (SIRS) and early organ dysfunction in patients with acute pancreatitis and the relationship with overall mortality.


METHODS
Patients with predicted severe acute pancreatitis of less than 48 h duration had daily organ dysfunction scores and SIRS criteria calculated. These features were then correlated with outcome.


RESULTS
Of 121 patients, 68 (56 per cent) did not develop organ dysfunction; only two of these patients died (mortality rate 3 per cent). Fifty-three (44 per cent) had early organ dysfunction, of whom 11 died (21 per cent). Organ dysfunction and persistent SIRS were both associated with an increased mortality rate, but on multivariate analysis only deteriorating organ dysfunction was an independent determinant of survival.


CONCLUSIONS
Early organ dysfunction in acute pancreatitis usually resolves and in itself has no significant influence on mortality. In contrast, worsening organ dysfunction was associated with death in more than half of the patients (11 of 20); it is this group of patients who should be classified as having severe acute pancreatitis.
Buter
A
A
Lister Department of Surgery, 16 Alexandra Parade, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
Imrie
C W
CW
Carter
C R
CR
Evans
S
S
McKay
C J
CJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality*; D010195:Pancreatitis / Q000150:complications / Q000401:mortality*; D011446:Prospective Studies; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality*; D013997:Time Factors