[Severity factors of acute renal failure in severe acute pancreatitis]

Luminiţa Chiuţu, E Georgescu, F Purcaru, R Nemeş, I Georgescu
Chirurgia 2006, 101 (6): 609-13

AIM: assessment of the severity factors of the acute renal failure (ARF) in the severe acute pancreatitis (SAP). 28 (32.55%) severe acute pancreatitis with acute renal failure (19 males and 9 females, aged between 30 and 67), treated by hemodialysis, selected from 86 severe acute pancreatitis with acute renal failure, admitted in the Hemodialysis Department of ICU in the last 6 years, were analyzed. The severity of the pancreatitis was assessed using the following criteria: clinico-biologic scores (Ranson > 3 and APACHE II > 8), the CT-scan (Balthazar score D and E and CTSI > 4), the presence of the organ and system dysfunctions assessed by Tran and Cuesta criteria and the presence of the abdominal compartment syndrome (abdominal pressure > 25 mm Hg). 8 dialyzed cases (28.5%) were operated on: 2 cholecystostomy, 2 cholecystectomy+choledocho-lithotomy+T tube drainage, 4 exploring laparotomy + drainage.

RESULTS: The following severity factors were identified: 1. the association of the ARF with other system and organ dysfunctions, the highest mortality rate being provided by the following associations: ARF + more than 3 organ and system dysfunctions and ARF + ARDS in assisted ventilated patients; 2. the abdominal compartment syndrome with abdominal pressure > 25 mm Hg; 3. severe sepsis and altered biological status of the patients. We registered a general mortality rate of 53.57% (15 deaths) and a postoperative mortality rate of 75% (6 deaths from 8 operated patients).

CONCLUSIONS: 1. Summing up the pathologic changes proper to the acute pancreatitis (enzymes and mediators releasing) with sepsis and abdominal compartment syndrome worsens the humoral and metabolic syndrome of the ARF. 2. The simultaneous presence of other organ and system dysfunctions makes the ARF in SAP one of the most severe forms. 3. ARF with anuria + ARDS in assisted ventilated patients and ARF + more than 3 associated organ and system dysfunctions are the clinical forms with the highest mortality rate. 4. The abdominal compartment syndrome is an important severity factor of the ARF because of its direct impact against the kidney and the organ and system dysfunctions which produces and worsens.

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