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Observational Study
. 2013 Jul;15(7):523-8.
doi: 10.1111/j.1477-2574.2012.00613.x. Epub 2012 Dec 5.

Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure

Ragesh Babu Thandassery  1 , Thakur Deen Yadav, Usha Dutta, Sreekanth Appasani, Kartar Singh, Rakesh Kochhar
Affiliations
Observational Study

Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure

Ragesh Babu Thandassery et al. HPB (Oxford). 2013 Jul.

Abstract

Background and aims: In acute pancreatitis (AP), patients with persistent organ failure [POF, duration of organ failure (OF) ≥48 h] and transient organ failure (TOF, duration of OF <48 h) have different outcomes. We have compared the clinical course and outcome of patients with severe AP (SAP) with TOF and POF in the first week of hospitalization as well as the impact of change in the OF score in the first week on patient outcome.

Methods: Consecutive patients with SAP were evaluated for OF and its dynamics during the first week of hospitalization. The modified multiple organ failure score (MOFS) was used to identify OF, grade its severity and monitor its progression. The clinical course and outcome of patients were studied.

Results: Of 114 patients, mean age 39.2 ± 13.7 years, 37 (32.5%) patients had no OF, 34 (29.8%) had TOF and 43(37.7%) had POF. Patients with POF had the higher infected necrosis, increased requirement for percutaneous drain placement, surgery and higher mortality as compared with those with TOF. The odds ratio for mortality with persistent and deteriorating OF was 26.2 [confidence interval (CI) 5.1-134.9] compared with only persistent OF.

Conclusion: The dynamics of OF in the first week of SAP predicts the clinical course and outcome. Persistent and deteriorating OF indicates a poor outcome.

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Figures

Figure 1
Figure 1
The hazard of mortality in the two groups based on progression of organ failure (Kaplan–Meier curve) Time of event (days) No change or improving MOFS (0) 5, 22, 32, 33, 44, 58 Worsening MOFS (1) 2, 2, 3, 3, 4, 7, 10, 11, 12, 15, 16, 17, 18, 19 Dy OF, dynamic change in organ failure.
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