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[The multiple-organ failure syndrome in acute pancreatitis. Its pathogenesis and treatment]
M Visconti1, P G Rabitti, G Uomo
1Divisione di Osservazione Medica, Ospedale Nuovo Pellegrini, Napoli.
Abstract:
Multiple organ system failure (MOSF) is a severe clinical process that causes progressive renal and liver failure. Acute pancreatitis (AP) can cause MOSF. Several series document high mortality rate from necrotizing forms is associated with MOSF. The authors observed 199 cases of acute necrotizing pancreatitis in 10 years, with a mortality rate of 14.1%. MOSF occurred in 14 cases, resulting in death in 100% of affected patients. In AP, MOSF follows hemodynamic abnormalities suspected to be secondary to activation of kinins system and other vasoactive peptides that are responsible for pathogenetic mechanism of disease. Similar hemodynamic abnormalities can be observed in septic shock. Then many authors suppose causes of MOSF in AP are local (abscess, infection of pancreatic necrosis) and systemic septic complications or translocation of enteric bacteria or their endotoxins from the gut lumen. So it is important to provide prophylactic use of antibiotics that are effective against expected bacteria and also achieve a therapeutic concentration in pancreatic tissue and juice. Fluid replacement, nutritional support and other therapeutic strategies must be employed to prevent MOSF. When the MOSF is clearly developed, medical and surgical measures are unuseful and the mortality rate is very high also in an intensive care unit.
Insights
Acute pancreatitis (AP) can lead to multiple organ system failure (MOSF), a condition with a 100% mortality rate in observed cases. Early intervention and prophylactic antibiotics are crucial for preventing MOSF in AP patients.
Area of Science:
- Gastroenterology and Hepatology
- Critical Care Medicine
- Pathophysiology
Context:
- Acute pancreatitis (AP) is a serious condition with potential for severe complications.
- Necrotizing forms of AP are particularly associated with high mortality.
- Multiple organ system failure (MOSF) represents a critical progression of AP, involving renal and liver failure.
Purpose:
- To analyze the incidence and outcomes of MOSF in patients with acute necrotizing pancreatitis.
- To explore the pathogenetic mechanisms linking AP to MOSF, including hemodynamic abnormalities and septic complications.
- To emphasize the importance of prophylactic strategies and early interventions in managing AP to prevent MOSF.
Summary:
- A 10-year study observed 199 cases of acute necrotizing pancreatitis, with a 14.1% overall mortality rate.
- MOSF occurred in 14 cases (7%), uniformly resulting in death.
- Pathogenesis involves hemodynamic disturbances and potential septic complications, suggesting a role for early antibiotic prophylaxis and supportive care.
Impact:
- Highlights the dire prognosis of MOSF in acute necrotizing pancreatitis, with current interventions proving ineffective once developed.
- Underscores the critical need for preventative measures, including prophylactic antibiotics and robust supportive care, to mitigate the risk of MOSF.
- Informs clinical practice regarding the management of severe AP, emphasizing proactive strategies to avoid progression to fatal organ failure.