Background & Aim: Organ dysfunction is a serious complication in severe acute pancreatitis (SAP), and pulmonary dysfunction (PD) is most frequently experienced. Incidence of PD complicating AP varies from 15 to 55%, and the severity of PD varies from mild hypoxemia without clinical abnormality to severe ARDS. It is conceivable that the presence of PD is correlated with the mortality rate in SAP, but there have been few clinical studies. This study aimed to clarify the clinical characteristics of PD associated with SAP.
Methods: We analyzed the data of 105 patients with SAP according to the Japanese criteria. Pulmonary dysfunction was defined as PaO2 <60mmHg (room air) or hypoxia requiring respirator-assisted ventilation during hospitalization. 1) We compare the clinical features between PD (-) group (n=53) and PD (+) group (n=52). 2) In PD (+) group, we surveyed the prognostic factors between survivor (n=22) and non-survivor (n=30). 3) Clinical outcome was investigated in 3 subgroups according to the timing of PD: on admission PD (within 24 h after admission, n=30); early PD (1-7 days after admission, n=10); and late PD (more than 7 days after admission, n=12).
Results: 1) The incidence of PD during hospitalization was 50%. Ranson score (5.1 vs. 2.7) and APACHE II score (13.7 vs. 6.4) on admission and frequency of necrotizing pancreatitis (79% vs. 36%) were significantly higher in PD (+) group. Among blood biochemical parameters on admission, base excess, urea nitrogen, creatinine (Cr), glucose, LDH, CRP, Ca, total protein, and PMN-elastase were significantly different between PD (-) group and PD (+) group. The incidence of infection during hospitalization (48% vs. 4%) and the mortality rate (58% vs. 2%) were significantly higher in PD (+) group. Moreover, the incidence of infection (56% vs. 18%) and the mortality rate (68% vs. 18%) were significantly higher in patients with PD together with multiple organ dysfunction syndrome (MODS) compared with PD alone. 2) In PD (+) group, prognostic factors on admission were AST, ALT, total bilirubin, Cr, Ca, and LDH (P <0.05). 3) In patients with on admission PD, early PD, and late PD, the incidences of infection were 47%, 0%, 75%, and the mortality rates were 63%, 10%, 83%, respectively. In PD of every phase, the mortality rates were higher in patients with PD together with MODS compared with PD alone.
Conclusions: The incidence of PD associated with SAP was high, and the incidence of infection and the mortality rate were higher in patients with PD (especially together with MODS). Systemic intensive care including a strategy against infection is needed in patients with PD together with MODS.