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Multicenter Study
. 2021 Mar;9(2):139-149.
doi: 10.1002/ueg2.12057.

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected

Jorge D Machicado  1 , Amir Gougol  2 , Xiaoqing Tan  3 , Xiaotian Gao  3 , Pedram Paragomi  2 , Ioannis Pothoulakis  2 , Rupjyoti Talukdar  4 , Rakesh Kochhar  5 , Mahesh K Goenka  6 , Aiste Gulla  7   8 , Jose A Gonzalez  9 , Vikesh K Singh  10 , Miguel Ferreira  11 , Tyler Stevens  12 , Sorin T Barbu  13 , Haq Nawaz  14 , Silvia C Gutierrez  15 , Narcis O Zarnescu  16 , Gabriele Capurso  17   18 , Jeffrey J Easler  19 , Konstantinos Triantafyllou  20 , Mario Pelaez-Luna  21 , Shyam Thakkar  22 , Carlos Ocampo  23 , Enrique de-Madaria  24 , Gregory A Cote  25 , Bechien U Wu  26 , Darwin L Conwell  27 , Phil A Hart  27 , Gong Tang  3 , Georgios I Papachristou  2   27
Affiliations
Multicenter Study

Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected

Jorge D Machicado et al. United European Gastroenterol J. 2021 Mar.

Abstract

Background: Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF.

Objective: We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF.

Methods: We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders.

Results: 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality.

Conclusion: In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.

Keywords: acute pancreatitis; mortality; natural history; organ failure; systemic inflammatory response syndrome, severe acute pancreatitis.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

FIGURE 1
FIGURE 1
Frequency distribution among acute pancreatitis subjects with systemic inflammatory response syndrome (SIRS; n = 892) and stratified by development of persistent organ failure (POF)—(a) by onset of SIRS and (b) by duration and maximal SIRS score
FIGURE 2
FIGURE 2
Area under the receiver operating characteristic (AUC) curve for prediction of persistent organ failure combining systemic inflammatory response syndrome characteristics
FIGURE 3
FIGURE 3
Frequency distribution among acute pancreatitis subjects with persistent organ failure (n = 166) based on—(a) onset, (b) duration, (c) number of organs affected, and (d) type of organ failing
See this image and copyright information in PMC

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