Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality.
BACKGROUND
Risk stratification of acute pancreatitis (AP) is important.


OBJECTIVE
To characterize patients with early severe pancreatitis, identify risk factors of severity, and assess their outcome.


METHODS
All consecutive patients with AP were included in the study. Severity assessment was done by APACHE II score, and presence and intensity of organ failure (OF). OF was graded from 1 to 4. Patients with severe pancreatitis were divided into early severe and late severe AP. The criterion for early severe AP (ESAP) was severe OF within 7 days of pancreatitis. Patients with ESAP were subdivided into fulminant and subfulminant AP based on timing of OF, i.e., <72 h and between 4 and 7 days of pancreatitis, respectively.


RESULTS
Of 282 patients with AP, 144 (51%) had mild AP, 32 (11.34%) had ESAP, and 106 (37.58%) had late severe AP. Of the ESAP patients (mean age 45.4 yr, 22 men), 10 patients had fulminant AP and 22 had subfulminant AP. Patients with ESAP had higher admission APACHE II compared to patients with late severe AP (14.9 vs 8.8, P<0.001). The proportion of patients with multiorgan failure was significantly higher in ESAP compared with late severe AP (75%vs 26%, P<0.001). The difference in mortality was significant in the fulminant, subfulminant, and late severe AP (90%, 72.7%, and 30%; P<0.001). Patients with ESAP accounted for 44% of all deaths. Predictors of mortality were development and early onset of organ failure.


CONCLUSIONS
We have characterized newer subgroups of patients with fulminant and subfulminant AP with important prognostic and management implications.
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Manik
M
Sharma
Debabrata
D
Banerjee
Pramod K
PK
Garg
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D009336:Necrosis; D010195:Pancreatitis / Q000145:classification* / Q000401:mortality* / Q000473:pathology; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors