Background: The clinically based Atlanta-classification describes OD as a dichotomous event either present or absent. The aim of this study was to identify key factors responsible for the occurrence, severity and/or duration of OD in SAP.
Methods: Between 10/2001 and 10/2004 data of 52 consecutive patients with SAP according to the Atlanta criteria were prospectively entered into a database. Patients were treated on intensive care unit (ICU) and all received a contrast enhanced CT during the first 72 hours. OD during the first 10 days after admission (respiratory, renal, cardiovascular) was graded using the Marshall score (grade 0 to 4 for each organ system). In addition, hypocalcemia was recorded according to the Atlanta criteria (present or absent). Data were entered into contingency tables and statistically analyzed. Results: In 3 patients SAP was diagnosed in the absence of OD because of necrosis >30%. Single OD was present in 16/49 (33%) patients and 33/49 (67%) showed multiple OD. 18/52 and 14/52 patients had necrosis of less than 30% and 30-50%, respectively. Necrosis >50% was present in 20/52 (38%) patients and was associated with hypo-calcemia and pulmonary but not with cardio-circulatory and renal OD (p<0.05 vs necrosis <30%). 12/20 (60%) patients with necrosis >50% were admitted to the hospital later than 48 hours after symptom onset as compared to 7/32 (22%) with less extensive necrosis (p<0.05). In 21/52 the BMI was >28kg/m2 and/or pre-existing cardiopulmonary co-morbidity was present. These 21 patients suffered in 76% (16/21) from OD lasting >72h despite the absence of pancreatic infection as compared to 39% (12/31) in patients without these conditions (p<0.05). Single OD < grade 3 either diagnosed at admission or later during the first 10 days after hospital admission had no influence on outcome. 15/18 patients (83%) with necrosis <30% had only transient OD during the first week despite initial OD grade 1 or 2. Three patients died late (i.e. after the third week of disease onset) due to multiple OD following infection of pancreatic necrosis. Conclusions: Admission later than 48 hours after symptom onset was associated with greater extent of necrosis. Cardiopulmonary co-morbidity and a BMI >28kg/m2 were associated with persistence of OD >72h despite ICU treatment. According to the Atlanta criteria a subgroup of patients with necrosis <30% and OD rapidly improving under fluid and oxygen support seems to be over-staged.
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