Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis
Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis
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DOI：
10.1136/gut.2004.039883
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发表时间：
2004-09-01
期刊：
影响因子：
24.5
通讯作者：
Abu-Hilal, M
中科院分区：
文献类型：
--
作者：
Johnson, CD;Abu-Hilal, M
背景：在预测的严重急性胰腺炎中，许多患者发生器官衰竭并恢复，无局部并发症，死亡率仅为14-30%。有研究表明，进行性早期器官衰竭患者中有一半可能死亡，但没有数据表明死亡或局部并发症与早期（第1周）器官衰竭的持续时间有关。目的：确定短暂性（48小时）早期器官衰竭患者的死亡率，并显示持续器官衰竭是否预示死亡或局部并发症。患者：共有290名预测的严重急性胰腺炎患者先前在一项lexpafant试验中进行了研究，这些患者来自英国18个中心的78家医院。方法：人工回顾试验数据库以确定：住院前7天器官衰竭（马歇尔评分大于或等于2）的存在、器官衰竭的持续时间和胰腺炎的结局（亚特兰大标准的死亡和并发症）。结果：174例（60%）患者出现早期器官衰竭。短暂性器官衰竭（n = 71）后，结果良好：1例死亡和29%的局部并发症。持续器官衰竭（n = 103）导致36例死亡和77%的局部并发症，与入院时或第一周后发生的器官衰竭无关。结论：预测重症急性胰腺炎第一周器官衰竭的持续时间与死亡或局部并发症的风险密切相关。48小时内器官衰竭消退提示预后良好；持续器官衰竭是随后死亡或局部并发症的标志。
Background: In predicted severe acute pancreatitis, many patients develop organ failure and recover without local complications, and mortality is only 14-30%. It has been suggested that half of patients with progressive early organ failure may die, but there are no data to relate death or local complications to duration of early (week 1) organ failure.Aims: To determine mortality rates in patients with transient (48 hours) early organ failure and to show whether persistent organ failure predicts death or local complications.Patients: A total of 290 patients with predicted severe acute pancreatitis previously studied in a trial of lexipafant, recruited from 78 hospitals through 18 centres in the UK.Method: Manual review of trial database to determine: the presence of organ failure (Marshall score greater than or equal to2) on each of the first seven days in hospital, duration of organ failure, and outcome of pancreatitis (death, complications by Atlanta criteria).Results: Early organ failure was present in 174 (60%) patients. After transient organ failure (n = 71), outcome was good: one death and 29% local complications. Persistent organ failure (n = 103) was followed by 36 deaths and 77% local complications, irrespective of onset of organ failure on admission or later during the first week.Conclusion: Duration of organ failure during the first week of predicted severe acute pancreatitis is strongly associated with the risk of death or local complications. Resolution of organ failure within 48 hours suggests a good prognosis; persistent organ failure is a marker for subsequent death or local complications.