Correlates of organ failure in severe acute pancreatitis.
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.
Wig
Jai Dev
JD
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. jdwsjni@hotmail.com
Bharathy
Kishore Gurumoorthy Subramanya
KG
Kochhar
Rakesh
R
Yadav
Thakur Deen
TD
Kudari
Ashwini Kumar
AK
Doley
Rudra Prasad
RP
Gupta
Vikas
V
Babu
Yellakanti Raghavendra
YR
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