2005 Abstracts: Factors Influencing Occurrence, Duration and Severity of Early Organ Dysfunction (OD) in Severe Acute Pancreatitis (SAP)
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Factors Influencing Occurrence, Duration and Severity of Early Organ Dysfunction (OD) in Severe Acute Pancreatitis (SAP)
Markus Gass, Beat Muggli, Markus Wagner, Eliane Angst, Daniel Inderbitzin, Daniel Candinas, Beat Gloor, Visceral and Transplant Surgery, Bern, Bern, Switzerland
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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