Clinical characteristics and management of patients with early acute severe pancreatitis: Experience from a medical center in China

Abstract

AIM:To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP). METHODS:Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixtynine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAP. The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared.RESULTS: Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31±0.68 vs 3.68±0.29, P<0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P<0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P<0.01), pancreas infection (15.9% vs 7.5%, P<0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P<0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P<0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE II score, Balthazar CT class, MODS and hypoxemia. CONCLUSION:ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.Tao HQ, Zhang JX, Zou SC. Clinical characteristics and management of patients with early acute severe pancreatitis: Experience from a medical center in China. World J Gastroenterol 2004; 10(6): 919-921

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

“…We also observed significant improvement in Marshall score and MODS of patients with resolution of IAH. The overall mortality rate in our study of approximately 23% is comparable to the 10%-50% reported in AP patients by others [18][19][20][21] . The mortality in ACS patients in our study (75%), however, was much higher than that in patients without ACS which is not acceptable for us, although post-injury ACS has been consistently reported to have a high mortality ranging from 25%-75%.…”

Practice Guidelines in Acute Pancreatitis

“…Although older literature suggested that 80% of deaths occur after several weeks of illness as a result of infected necrosis, more recent surveys have shown considerable variation with several reports showing a reasonably even distribution of early deaths (within 1-2 wk) versus later deaths (46,72,76,150,151,163), a few showing the majority of deaths within the first 2 wk (67,75), and others showing the majority of deaths after the first 2 wk (59,89,135). These variations reflect a variety of influences including percentage of very ill patients referred to a reporting hospital compared to patients admitted directly.…”

Clinical outcomes in patients with ICU-related pancreatitis

“…However, severe acute pancreatitis is still characterized by rapidly progressive multiple organ failure and high mortality, and both surgical and conservative therapies yield poor outcomes [31] . Thus, most emphasis is placed on preventing the progression to multiple organ failure [32,33] . Congestive heart failure was more common in VRP patients than in PRRF patients and was a good prognostic predictor for ICU mortality in patients with VRP.…”