Acute pancreatitis: which patient is most at risk?

This prospective study aimed to pinpoint acute pancreatic patients who are at a higher risk of clinical deterioration. Once identified, they can be given more costly intensive-care therapy or transferred promptly to hospitals with specialized equipment. Our study included 217 patients with acute pancreatitis. All of them underwent computed tomography within 72 h of admission. Initial organ failure was defined according to the Atlanta classification (arterial pO2, < or = 60 mm Hg; serum creatinine, > 2 mg/dl after rehydration). Forty-two (19%) of the 217 patients had initial organ failure, and 13 (31%) of these deteriorated (i.e., 10 of them needed artificial ventilation, and three, dialysis treatment). Deterioration of initial organ failure was significantly more frequent in alcohol- than in non-alcohol-induced acute pancreatitis (p = 0.005). One hundred seventy-five (81%) patients had no initial organ failure, and 12 (7%) of these deteriorated. All needed artificial ventilation, and two of them dialysis treatment also. There was no significant correlation between etiology and deterioration in these patients. Patients with alcohol-induced acute pancreatitis and initial organ failure represented a major group at risk and should be closely monitored or transferred to specialized units, whereas patients without initial organ failure have a lower risk of later developing organ failure and usually do not need intensive care.