title: Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure.
abstract: OBJECTIVE
  In acute pancreatitis (AP), patients with persistent organ failure [POF, duration of organ failure (OF) ≥48 h] and transient organ failure (TOF, duration of OF <48 h) have different outcomes. We have compared the clinical course and outcome of patients with severe AP (SAP) with TOF and POF in the first week of hospitalization as well as the impact of change in the OF score in the first week on patient outcome.
  
  
  METHODS
  Consecutive patients with SAP were evaluated for OF and its dynamics during the first week of hospitalization. The modified multiple organ failure score (MOFS) was used to identify OF, grade its severity and monitor its progression. The clinical course and outcome of patients were studied.
  
  
  RESULTS
  Of 114 patients, mean age 39.2 ± 13.7 years, 37 (32.5%) patients had no OF, 34 (29.8%) had TOF and 43(37.7%) had POF. Patients with POF had the higher infected necrosis, increased requirement for percutaneous drain placement, surgery and higher mortality as compared with those with TOF. The odds ratio for mortality with persistent and deteriorating OF was 26.2 [confidence interval (CI) 5.1-134.9] compared with only persistent OF.
  
  
  CONCLUSIONS
  The dynamics of OF in the first week of SAP predicts the clinical course and outcome. Persistent and deteriorating OF indicates a poor outcome.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ragesh Babu
authors.initials: RB
authors.lastname: Thandassery
authors.forename: Thakur Deen
authors.initials: TD
authors.lastname: Yadav
authors.forename: Usha
authors.initials: U
authors.lastname: Dutta
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Appasani
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
mesh_terms: D018806:APACHE; D000328:Adult; D001424:Bacterial Infections / Q000209:etiology; D016009:Chi-Square Distribution; D018450:Disease Progression; D004322:Drainage; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D063305:Organ Dysfunction Scores; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors