Assessment of organ failure in 168 patients with acute pancreatitis in a single university center: Which patient is at risk?

Abstract

Introduction: About 10 to 15% of patients with acute pancreatitis (AP) are defined as severe or critical with up to 50% mortality rate. The aim of the study is to evaluate organ failure and function in patients with AP and to determine its relationship to severity and mortality. Method: Prospective data collection of patients with AP admitted in a single University Hospital. Patients were evaluated with severity scores (SOFA, MARSHALL and APACHE II) and defined its severity in mild and not-mild categories (moderate, severe and critical). Organ failure was defined according to the Atlanta classification. Cardiac, renal, lung and hematologic function were evaluated at admission. Statistical analysis was performed using t Student and Chi square test. Results: We evaluated 168 patients. Admission APACHE II was 5.14 (±3.86), SOFA 1.4 (±1.94) and Marshall 0.52 (±1.36). 26 patients (15.5%) had organ failure. Respiratory (61.6%) and renal (15.4%) failures were the most frequent. There was a relationship between mortality and respiratory failure (p = 0.017). 23% of patients had hypoxemia at admission. Rifle classification was related to severity (p = 0.025). Cardio-circulatory failure was related to mortality (p = 0.0357). Not-mild forms showed greater CPK (p = 0.0214) and troponin levels (p = 0.0001). D-dimer was related to severity (p = 0.001) and respiratory failure (p = 0.0212). Conclusion: Respiratory and renal failures were the most prevalent. Respiratory and cardio-circulatory failures were related to mortality. Elevated troponin, CK-MB and Rifle classification were related to severity. D-dimer was an important indicator of severity.