Severe Acute Pancreatitis: The Continued Challenge

摘要

Acute pancreatitis (AP) remains a substantial problem, with the reported incidence usually being in the range of 200-400/million inhabitants/year. Among patients with AP, ≈15% are classified as having AP according to the Atlanta classification system (1), and the reported mortality rate for such patients may be as high as 40% (2,3). Moreover, mortality is usually associated with multiple organ dysfunction syndrome (MODS), which correlates with the number of failing organs and in up to 50% of cases occurs during the first week (2-4). This development, i.e. the progression and exacerbation of the acute-phase response into an uncontrolled systemic inflammation with the potential development of organ dysfunction, is well known and several prognostic markers have been described, including pro- and anti-inflammatory cytokines during the initial phase of AP (2,3). It seems that initial management is most important in order to control the further development of the acute inflammatory response. This includes the maintenance of microcirculatory dysfunction in order to minimize ischemia/reperfusion injury and exacerbation of the pro-inflammatory response (5,6).