Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records.
BACKGROUND
Extrapancreatic organ dysfunction is the key determinant of mortality in acute pancreatitis (AP). This study aimed to document the frequency and duration of individual organ dysfunction in all fatalities caused by AP in a large, population-based cohort.


METHODS
All deaths caused by AP in Scotland between 2000 and 2006 inclusive were analysed (n = 1024).


RESULTS
The median time lapse between the onset of AP and death was 6 days (interquartile range [IQR] 17 days); that between the onset of organ dysfunction and death was 3 days (IQR 7 days). There was no apparent bimodal distribution. The majority of patients had single- (384 patients) or two-system (242 patients) extrapancreatic organ dysfunction. Pulmonary dysfunction was most prevalent (30% of organ-specific entries, 198/660), followed by cardiovascular (18%, 117/660), renal (16%, 108/660), liver (11%, 71/660), gastrointestinal (9%, 59/660), haemorrhage (6%, 38/660), coagulopathy (5%, 31/660) and central nervous system (6%, 38/660) dysfunction.


CONCLUSIONS
Death in AP occurs early in the disease course. The present findings support the primacy of pulmonary injury as the modal pattern of organ dysfunction in severe AP, with increased frequencies of cardiovascular and renal compromise in fatal AP.
Mole
Damian J
DJ
Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK. damian.mole@ed.ac.uk
Olabi
Bayanne
B
Robinson
Victoria
V
Garden
O James
OJ
Parks
Rowan W
RW