Autopsy Study of Patients Dying Due to Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis (AP) results in mortality due to persistent organ failure (POF) and infected necrosis. There is scant information on this topic and the correlation between organ findings and organ failure is scarce. We studied the findings in the pancreas and other organs in autopsies of AP patients and correlated these to clinical POF and infected or sterile necrosis. Methods: Medical records of 2,236 patients admitted from 2004 to 2013 with AP were reviewed; 82 patients on whom autopsies were performed had AP listed as a finding. Only 27 had death due to AP, while the remaining had AP as a postmortem diagnosis. Findings in the pancreatic and peripancreatic area (interstitial, necrotizing, or hemorrhagic), pulmonary, cardiovascular, renal, and other organs were noted. POF and pancreatic necrosis prior to death were abstracted from chart review. Results: Hemorrhagic AP on autopsy was seen in 8 of 27 cases (29.6%) and 7 of 8 (87.5%) had POF. Necrotizing AP on autopsy was seen in 24 of 27 cases (88.9%) and 20 of 24 had POF (83.3%). Of the 24 with necrotizing AP, combination pancreatic and peripancreatic necrosis was seen in 13 (54.2%), and 12 of 13 had POF (92.3%). Peripancreatic necrosis alone was present in 8 of 24 (33.3%), and 7 of 8 had POF (87.5%). Pancreatic necrosis alone was seen in 3 of 24 (12.5%), and 1 of 3 had POF (33.3%). Clinical findings of respiratory failure (ARDS), cardiovascular failure (heart failure, shock), and renal failure (hemodialysis) were correlated to autopsy findings of pleural effusions, acute diffuse alveolar damage, pulmonary congestion, dilated cardiomyopathy, and acute tubular necrosis. The incidence of secondary complications of AP from chart review and autopsy reports are listed in the attached table. Conclusion: Hemorrhagic AP on autopsy was not uncommon (8 of 27, 29.6%) and 7 had POF (87.5%). Necrotizing AP was common on autopsy (24 of 27, 88.9%) and 20 had POF (83.3%). All with pulmonary POF had ARDS at autopsy, and all with renal POF had ATN at autopsy. Only 47% (8 of 17) with cardiovascular POF had cardiac findings at autopsy. Disclosure - Dr. Santhi Vege - Royalty for uptodate for chapters on pancreatic diseases; Consulting for calcimedica.Table 1: Correlation of Clinical Complications of AP With Autopsy Findings