title: Correlates of organ failure in severe acute pancreatitis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. jdwsjni@hotmail.com
authors.forename: Jai Dev
authors.initials: JD
authors.lastname: Wig
authors.forename: Kishore Gurumoorthy Subramanya
authors.initials: KG
authors.lastname: Bharathy
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
authors.forename: Thakur Deen
authors.initials: TD
authors.lastname: Yadav
authors.forename: Ashwini Kumar
authors.initials: AK
authors.lastname: Kudari
authors.forename: Rudra Prasad
authors.initials: RP
authors.lastname: Doley
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Yellakanti Raghavendra
authors.initials: YR
authors.lastname: Babu
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D009336:Necrosis; D010195:Pancreatitis / Q000401:mortality* / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index