Abstract

Introduction: High mortality rates in severe acute pancreatitis (SAP) have been attributed for quite some time to number and severity of organ failure (OF), rather than on their period of onset. We investigated whether rapidity of onset of organ failure determines the outcomes in SAP.
Patients and methods: We performed a post hoc analysis from a prospectively maintained database of 331(66.1%) of 501 consecutive patients (mean age 41.3 ± 15.2 years, 69.5% males) of acute pancreatitis over a three-year period, who fulfilled revised Atlanta criteria for SAP. Patients were divided into early severe acute pancreatitis (ESAP: 115, 34.7 %) and late severe acute pancreatitis (LSAP: 216, 65.3 %) if OF developed within or after 7 days of disease onset. ESAP was subdivided into fulminant (FAP: 49 of 115, 42.6%) and sub-fulminant (SFAP: 66, 57.4%) groups with onset of organ failure within 72 hours and 72 hours to 7 days of disease respectively.
Results: Within the overall mortality rate of 27% (89 of 331) in SAP, significantly higher deaths occurred in ESAP group (49.6%, 57/115) compared to LSAP (15.7%, 34/216, p<0.05). Within ESAP, it was significantly higher in those with FAP (63.3%, 31/49) than those with SFAP (39.4%, 26/66). Respiratory failure accounted for 50.9% (29/57) of deaths in ESAP, but only in 20.6% (7/34) in LSAP (p<0.01). Sepsis, on the other hand, accounted for only 31.6% (18/57) in ESAP but 70.6% (24/34) in LSAP (p<0.01).
Conclusion: Our observation suggests that the time of onset of organ failure in SAP is an important determinant of death, mortality being higher in those with a fulminant (SFAP) or rapid course (ESAP) than those where the disease progresses slowly (LSAP).

Keywords

Pancreas, pancreatitis, severity, mortality, pancreatic necrosis, outcome, Early acute severe Pancreatitis, Fulminant Acute Pancreatitis, Subacute Severe Pancreatitis, Late Severe Acute Pancreatitis