Organ Failure In Acute Pancreatitis

摘要

Organ dysfunction or organ failure is a common clinical feature of acute pancreatitis (AP). The threshold for definition of organ failure adopted at the International Symposium on Acute Pancreatitis held in Atlanta, GA in 1992 was set at significant impairment of organ or system function. Intensive care practitioners have developed a number of different scoring scales for organ dysfunction, which allow grading of its severity. In AP, prognosis deteriorates progressively with an increase in the number of systems involved, but according to currently accepted definitions any patient with any organ failure is classified as having severe AP. Almost half of patients with predicted severe disease have organ failure at the time of admission to hospital. It is now clear that many patients with early organ failure recover without further complications. Organ failure during the first week of AP can regress, with subsequent very low mortality, but if the organ failure persists to the end of the first week the outlook is extremely poor. Organ failure which resolves within 48 h of onset is associated with a very low mortality. By contrast, organ failure which persists for >48 h is associated with a 35% mortality rate. Early organ failure (at the time of admission to hospital) is associated with an increased risk of pancreatic necrosis. It seems reasonable to suppose that the extent of pancreatic injury may directly determine the severity and duration of the inflammatory response. The presence of persistent organ failure is clearly associated with the presence of local complications. The association between persistent organ failure and subsequent fatal outcome and the low mortality rate in patients with transient organ failure suggest that, if organ failure is present early during AP, aggressive treatment to reverse the organ failure may have a protective effect and could improve outcome.