Correlates of organ failure in severe acute pancreatitis.

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.