No strict correlation between necrosis and organ failure in acute pancreatitis

The aim of this study was to determine the relationship between pancreatic necrosis and organ failure in acute pancreatitis. Two hundred seventeen patients with acute pancreatitis were prospectively included. All of them had been examined by computed tomography (CT) within 72 hours of admission. Initial organ failure was defined according to the Atlanta classification (arterial pO2 <60 mm Hg, serum creatinine >2 mg/dL after rehydration). Organ failure during the total hospital stay was defined as necessity for artificial ventilation and/or dialysis treatment, independent of initial organ failure. One hundred seventy-five (81%) patients had interstitial and 52 (19%) necrotizing pancreatitis. Forty-two (19%) had initial organ failure and 54 (25%) organ failure during the total hospital stay. There was a significant correlation between the incidence of initial pancreatic necrosis and initial organ failure as well as initial pancreatic necrosis and organ failure during hospital stay (p < 0.001). However, 24 (57%) of the 42 patients with pancreatic necrosis had no initial organ failure, and 19 (45%) no organ failure during hospital stay, and vice versa, 24 (14%) patients had initial and 31 (18%) organ failure during the total hospital stay in the absence of pancreatic necrosis. Initial organ failure and organ failure during the total hospital stay were independent of the extent of pancreatic necrosis. The incidence of initial organ failure and organ failure during the total hospital stay increased significantly with the CT score (p < 0.001). However, 24 (15%) and 31 (18%) of the patients with interstitial pancreatitis had initial organ failure and organ failure during the total hospital stay, respectively. Patients with pancreatic necrosis are not necessarily at risk of having initial organ failure or organ failure during the total hospital stay and vice versa. Thus, these groups should be considered separately in therapy studies.