title: Hypotension in the first week of acute pancreatitis and APACHE II score predict development of infected pancreatic necrosis.
abstract: BACKGROUND
  Hypotension and intestinal mucosal ischemia lead to bacterial translocation from the gut lumen into systemic circulation.
  
  
  OBJECTIVE
  The purpose of this study was to determine the strength of association between different types of organ failure (OF): hypotension (cardiovascular system failure), renal failure, respiratory failure, CNS failure and coagulopathy in the first week of acute pancreatitis (AP) and the subsequent development of infected pancreatic necrosis (IN).
  
  
  METHODS
  Consecutive patients with AP were evaluated for OF and its severity in the first week of hospital admission. Modified multiple organ failure score (MOFS) was used to identify and grade severity of OF. MOFS of ≥2, lasting for more than 48 h was defined as OF. Occurrence of IN (isolation of bacteria in necrosectomy specimen or image guided fine needle aspiration of pancreatic necrosis) was compared between groups with and without OF.
  
  
  RESULTS
  Of the 81 patients, mean age was 40.1 ± 14.4 years and 55 were males; 60 (74 %) patients had OF and 13 (16 %) patients had IN. Occurrence of IN was not significantly different between patients with OF (18.3 %) and without OF (14.3 %), p = 0.48. However IN occurred in 10 % of patients without and 33.7 % patients with hypotension, p = 0.01. The rest of the organ systems analyzed did not show any significant difference in occurrence of infected necrosis. On multivariate analysis independent predictors of occurrence of IN were hypotension (odds ratio, OR 2.5, p < 0.001) and APACHE II score at 24 h of hospital admission (OR 4.77, p < 0.001).
  
  
  CONCLUSIONS
  Hypotension in the first week of AP and APACHE II score predict development of IN.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, 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; D000208:Acute Disease; D000328:Adult; D018988:Bacterial Translocation; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D061705:Image-Guided Biopsy; D007422:Intestines / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors