核医学と放射線治療

Clinical Characteristics of Patients with Acute Pancreatitis Coexisting with Organ Failure: A Retrospective Cohort Study

Abstract

Chunyi Gui, Weidong Wu, Ruoqing Lei and Min Wang

Purpose: Acute pancreatitis is a systemic disease, and is usually closely associated with organ failures. This study was to investigate the pattern of organ failure in the course of acute pancreatitis. Recent Findings: A total of 783 severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) patients who were sequentially treated in Department of Surgery, Ruijin Hospital from January 2001 to December 2008 were retrospectively analyzed. All the patients were divided according to their outcomes into two groups: deceased group and survival group. The relationship between the happening of organ failure and outcome of the patients were observed. Then peripheral blood level of endotoxin core antibody and TNF-α between SAP and MSAP groups were compared. Among the 783 patients, the numbers of MSAP patients and SAP patients were 573 and 210 respectively. Overall, 698 patients were survived, which represents 89.1% of the total patients. Furthermore, 273 patients or 34.9% of the total were diagnosed with organ failure. There were 109 patients with single organ failure, 2 of which died; 81 and 60 patients with 2 organs failure and 3 organs failure respectively. In each group 30 patients died. Finally there were 23 patients with 4 or more organs failure and none of them survived. The rate is 15.3% (107/698) of the patients with single organ failure in survival group, while the corresponding number is only 2.4% (2/85) in deceased group. On the contrary, only 11.6% (81/698) patients in the survival group had multiple organ failure, while the number is 97.6% (83/85) in the deceased group. Respiratory, renal, cardiovascular, neurological, hematologic and hepatic failure occurred in 206, 80, 103, 92, 41, and 27 patients, with the incidence of 26.3%, 10.2%, 13.2%, 11.7%, 5.2%, and 3.4%; and the mortality rates were 38.8%, 63.8%, 49.5%, 37.0%, 53.7%, and 44.4% respectively. Peripheral blood levels of TNF-α and endotoxin core antibody in patients with SAP were significantly different with that of MSAP. Summary: In the course of acute pancreatitis, respiratory and cardiovascular failure has the highest incidence, and renal, hematologic failure is associated with poorest prognosis.