CONTEXT: The clinical course of severe acute pancreatitis may be complicated by organ failure. OBJECTIVE: We studied the incidence of organ failure and the correlation of the extent of necrosis and infective necrosis with organ failure. METHODS: The medical records of 161 patients with severe acute pancreatitis and persistent organ failure over a 4-year period were studied. MAIN OUTCOME MEASURES: Pancreatic necrosis on CT was graded as <30%, 30-50% and >50% necrosis. Infected necrosis was diagnosed on the basis of a positive culture of fine needle aspiration or of a surgical specimen. Organ failure was defined according to the Atlanta criteria. Patient demographics, extent of pancreatic necrosis and presence of infection were correlated with organ failure. INTERVENTION: All patients were managed by a predefined treatment protocol. RESULTS: Of the 161 patients (124 males, 37 females, mean age 41.5+/-15.0 years), 52.2% had organ failure. In patients with organ failure, 48.8% had one, 33.3% two and 17.8% had multiple organ failure. Pulmonary failure was the most common organ dysfunction (76.2%). A more advanced age of patients and a higher APACHE II score were significant risk factors for the development of organ failure. Pancreatic necrosis on CT scan in patients with one, two and three organ failures was 48.8%, 51.8% and 83.3%, respectively while, in patients without organ failure, only 28.6% had more than 50% necrosis (P<0.001). No correlation was found between infected necrosis and organ failure. Overall mortality was 47.8% and mortality increased with an increasing number of organ failures. CONCLUSION: Persistent organ failure occurred in 52.2% of our patients with severe acute pancreatitis. The advanced age of the patients, a higher APACHE II score and the extent of necrosis, but not infected necrosis, emerged as significant correlates of organ failure.
CONTEXT: The clinical course of severe acute pancreatitis may be complicated by organ failure. OBJECTIVE: We studied the incidence of organ failure and the correlation of the extent of necrosis and infective necrosis with organ failure. METHODS: The medical records of 161 patients with severe acute pancreatitis and persistent organ failure over a 4-year period were studied. MAIN OUTCOME MEASURES: Pancreatic necrosis on CT was graded as <30%, 30-50% and >50% necrosis. Infected necrosis was diagnosed on the basis of a positive culture of fine needle aspiration or of a surgical specimen. Organ failure was defined according to the Atlanta criteria. Patient demographics, extent of pancreatic necrosis and presence of infection were correlated with organ failure. INTERVENTION: All patients were managed by a predefined treatment protocol. RESULTS: Of the 161 patients (124 males, 37 females, mean age 41.5+/-15.0 years), 52.2% had organ failure. In patients with organ failure, 48.8% had one, 33.3% two and 17.8% had multiple organ failure. Pulmonary failure was the most common organ dysfunction (76.2%). A more advanced age of patients and a higher APACHE II score were significant risk factors for the development of organ failure. Pancreatic necrosis on CT scan in patients with one, two and three organ failures was 48.8%, 51.8% and 83.3%, respectively while, in patients without organ failure, only 28.6% had more than 50% necrosis (P<0.001). No correlation was found between infected necrosis and organ failure. Overall mortality was 47.8% and mortality increased with an increasing number of organ failures. CONCLUSION: Persistent organ failure occurred in 52.2% of our patients with severe acute pancreatitis. The advanced age of the patients, a higher APACHE II score and the extent of necrosis, but not infected necrosis, emerged as significant correlates of organ failure.