Effects of duration of early organ dysfunction and therapeutic strategy on outcomes in patients with severe acute pancreatitis

Abstract

To investigate the characteristics of early organ dysfunction in patients with severe acute pancreatitis (SAP) and therapeutic regimens. A total of consecutive 74 patients with a confirmed diagnosis of SAP admitted between January 2000 and June 2005 were divided into two groups, transient group (<or=72 h, n = 20) and persistent group (>72 h, n = 54). The differences in local complications and mortality were compared between the two groups. Among the seventy-four SAP patients, the incidence rate of cardiovascular dysfunction was 80%, respiratory dysfunction 47%, hepatic dysfunction 37% and renal dysfunction 20%. The incidence of multiple organ dysfunction in transient group was much lower than that in persistent group (P < 0.01). The local complications and death in transient group patients were less than that in persistent group (P = 0.038, P = 0.054, respectively), irrespective of onset of organ dysfunction on admission or later during the first week. The important determinant of risk of death from SAP is the persistence of early organ dysfunction for more than 72 h. Consequently, aggressively ameliorating the blood perfusion and the oxygenation in tissue is the priority in reducing organ dysfunction or shortening the duration of organ dysfunction.