Persistent early organ failure: defining the high-risk group of patients with severe acute pancreatitis?

OBJECTIVES: The aim of our study was to evaluate the clinical significance of prolonged organ failure during the first week of severe acute pancreatitis and the potential correlation with final outcome.

METHODS: Of 234 patients with acute pancreatitis admitted to our department between January 2002 and December 2006, 64 patients with predicted severe acute pancreatitis were studied according to the presence and also the duration of organ failure early in the course of the disease.

RESULTS: Transient (<48 h duration) or persistent (>48 h duration) early organ failure (EOF) was present in 33 of 64 patients (51.5%). All 9 deaths (9/55 patients; 16.5% mortality) were recorded among patients who developed pancreatic necrosis, and the combination ofEOF and necrosis was present in most (8/9) patients with fatal outcome (P = 0.009). Persistent EOF was significantly associated with development of infected necrosis (P = 0.037) and worse outcome (P=0.028) as well. Multivariate analysis with backward elimination identified the duration of EOF as an independent factor affecting outcome.

CONCLUSIONS: Persistent organ failure early in the course of acute pancreatitis is a major determinant of outcome. In combination with pancreatic necrosis, survival rate is strongly compromised.