Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis

Abstract

Early organ dysfunction in acute pancreatitis usually resolves and in itself has no significant influence on mortality. In contrast, worsening organ dysfunction was associated with death in more than half of the patients (11 of 20); it is this group of patients who should be classified as having severe acute pancreatitis.

Practice Guidelines in Acute Pancreatitis

“…The progression of single organ failure to multisystem organ failure is a major determinant in the high mortality associated with organ failure at admission (83). Survival among patients with organ failure at admission has also been shown to correlate with the duration of organ failure (71,72,151). When organ failure is corrected within 48 h, mortality was close to 0.…”

“…It has already been noted that patients with organ failure at admission have a higher mortality than those who do not have organ failure at admission (50,61,69,71,72,83,163). It has also been determined that for patients who develop organ failure for the first time after admission, mortality may be as high when organ failure is experienced at admission (71,72,83,163).…”

“…Several reports have pointed out that patients with organ failure at admission have a higher mortality than those who do not experience organ failure at admission (50,61,69,71,72,83,163). The progression of single organ failure to multisystem organ failure is a major determinant in the high mortality associated with organ failure at admission (83).…”

What is New in Acute Pancreatitis?

“…Worsening [8] or persistent [9] organ failure during first week has been strongly correlated with severity of disease and mortality. According to a recent report, the 48-hour APACHE II score has improved predictive value compared with the admission scores and deteriorating APACHE II score at 48 hours after admission may identify patients at risk for an adverse outcome [10].…”

The Bedside Index for Severity in Acute Pancreatitis: a systematic review of prospective studies to determine predictive performance

“…The severity of acute pancreatitis is the major determinant of clinical outcomes with mortality ranging from 1–3% in mild to over 20% in severe acute pancreatitis (SAP), defined by the presence and persistence of organ failure [5,6]. A major challenge for care providers is to predict the development of severe pancreatitis early in the course, which would improve patient management and resource utilization.…”