Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis.
BACKGROUND
In predicted severe acute pancreatitis, many patients develop organ failure and recover without local complications, and mortality is only 14-30%. It has been suggested that half of patients with progressive early organ failure may die, but there are no data to relate death or local complications to duration of early (week 1) organ failure.


OBJECTIVE
To determine mortality rates in patients with transient (<48 hours) and persistent (>48 hours) early organ failure and to show whether persistent organ failure predicts death or local complications.


METHODS
A total of 290 patients with predicted severe acute pancreatitis previously studied in a trial of lexipafant, recruited from 78 hospitals through 18 centres in the UK.


METHODS
Manual review of trial database to determine: the presence of organ failure (Marshall score > or =2) on each of the first seven days in hospital, duration of organ failure, and outcome of pancreatitis (death, complications by Atlanta criteria).


RESULTS
Early organ failure was present in 174 (60%) patients. After transient organ failure (n = 71), outcome was good: one death and 29% local complications. Persistent organ failure (n = 103) was followed by 36 deaths and 77% local complications, irrespective of onset of organ failure on admission or later during the first week.


CONCLUSIONS
Duration of organ failure during the first week of predicted severe acute pancreatitis is strongly associated with the risk of death or local complications. Resolution of organ failure within 48 hours suggests a good prognosis; persistent organ failure is a marker for subsequent death or local complications.
University Surgical Unit, F Level, Centre Block (816), Southampton General Hospital, Southampton SO16 6YD, UK. c.d.johnson@soton.ac.uk
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CD
Johnson
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Abu-Hilal
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000401:mortality; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality*; D011379:Prognosis; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology