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Incidence of organ failure in patients with severe acute pancreatitis

Introduction

The clinical course of severe acute pancreatitis (SAP) may be complicated by a variety of organ failures, an ominous evolution associated with high mortality rates. We aimed to describe a population of patients with SAP and to quantify the type and frequency of organ failures in these patients.

Methods

Retrospective analysis of all medical records of patients admitted to the MICU between January 1995 and January 2001 due to SAP. SAP was defined as acute pancreatitis associated with at least one organ failure. Organ failure was defined as a score of 3 or 4 according to the SOFA score.

Results

Seventy-two patients (44 male, 61%) met the criteria of SAP. The mean age was 54 (range 24–90) years. The average length of stay in the MICU was 21 days (range 3–133). Average SAPS II score at admission was 42 (range 19–83), and SOFA score was 8 (range 1–22). Thirty-six per cent were referred from other ICUs in other hospitals. The most frequent causes of SAP were gallstones (32%), alcohol (24%), idiopathic (13%), hyperlipidemia (10%), and post-ERCP pancreatitis (8%). Forty patients (56%) developed respiratory failure with need for mechanical ventilation; nine out of these patients developed ARDS. Thirty-one patients (43%) developed renal failure, 24 of these patients required renal replacement therapies. Fifty-one per cent of patients developed cardiovascular failure with need for vasopressors. Thrombocytopenia < 50,000/ml occurred in 14 patients (19%), and hepatic failure in 15 patients (21%). Eight patients (11%) developed two organ failures, 16 patients (22%) developed three organ failures and 15 patients (21%) developed four or more.

Bacteremia was detected in 32 patients (44%), and in 13 patients the positive blood cultures were interpreted as contaminants. According to computertomographic criteria, 54 patients (75%) were diagnosed with pancreatic necrosis. Pancreatic cultures were obtained in 30 patients. Microbes were cultured from necrotic areas in 17 of these patients. Seventeen patients (24%) underwent surgery (on average, two interventions, range 1–6) because of infected necrosis or progressive organ failure. Mortality in patients requiring surgery was 53%; that in those not requiring surgery 20%. Overall mortality was 28%.

Conclusions

In an unselected population of patients with SAP, of which 75% also had acute necrotising pancreatitis, organ failure is common. Respiratory failure is most common (56%), followed by cardiovascular failure (51%), renal failure (43%), hepatic failure (21%) and coagulopathy in 19% of patients. At 28%, mortality in these patients remains high.

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Lapauw, S., Wilmer, A. & Bobbaers, H. Incidence of organ failure in patients with severe acute pancreatitis. Crit Care 7, P211 (2003). https://doi.org/10.1186/cc2100

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  • DOI: https://doi.org/10.1186/cc2100

Keywords

  • Pancreatitis
  • Thrombocytopenia
  • Respiratory Failure
  • Acute Pancreatitis
  • Organ Failure