Organ failure in acute pancreatitis and its impact on outcome in critical care

Abstract

The most important determinant of mortality in acute pancreatitis is organ failure (OF). The aim of this prospective observational study was to determine the incidence of organ failure in acute pancreatitis and its relation with the extent of necrosis and outcome. Sixty-one patients were divided into 3 groups: no organ failure (NOF), transient organ failure ( 48 hrs) (POF). Of 61 patients, 30 patients had no organ failure (49.1%), while 11 patients (18%) had TOF and 20 patients (32.7%) had POF. The mean age was 46.5 yrs with male predominance. Pulmonary and renal failures were the most common (32%), followed by CVS (cardiovascular system), coagulation system and CNS (central nervous system). Fourteen (46.4%) patients had one or two OF, 17 (56.6%) had more than two OF. There were no deaths in patients with up to two organ failures but a 70% (7) death rate in those with three organ involvement, 80% (4) with four and 100% with five OF. The percentage of pancreatic necrosis was evaluated for its relationship with organ failure. In the NOF group 19 (63.3%) patients had no necrosis, as compared to 11 patients with necrosis in TOF and POF groups (35.4%). Out of 61 patients, 13 patients died. All 13 patients who expired belonged to the POF group (p <.001). Early persisting and deteriorating organ failure had the worst outcomes. There was an increase in mortality with an increasing number of organs involved. The extent of necrosis was directly related with incidence of organ failure.

Keywords

• pancreatitis
• mortality
• organ failure
• ICU
• critical care
• pancreatic necrosis
• morbidity
• MMOFS
• bedisde index for severity in acute pancreatitis
• BISAP