Acute renal failure profile and prognostic value in severe acute pancreatitis

BACKGROUND: Acute renal failure (ARF complicating severe acute pancreatitis (SAP) carries a high mortality. Clinically useful scores to define patient s who will develop this complication are lacking, We try to determine the i ncidence of ARF and variables predicting the appearance and severity of the episodes. MATERIAL AND METHOD: Retrospective study of all SAP patients admitted in an intensive care unit between 1991 and 1998 (n = 154). RESULTS: ARF incidence was 42%, Haemodynamic instability, APACHE II and Ran son score were related to ARF development, 62.2% of severe ARF patients had multiple organ failure (MOF). Mortality was 71.2% compared to 6.8% in pati ents without ARF (39.9% in mild ARF and 94.6% in severe ARF). Etiology rela tes to mortality (prerenal [46.4%3, after severe hypotensive episode [71.4% ], in MOF [93.3%]; p < 0,0051. 63.6% patients required replacement therapy (hemofiltration [HF] 95,5%), with a mortality of 89.3% (100% for intermitte nt dialysis compared to 88% with HR. In 32% patients treated with HF, ARF i mproved (when initiated early mortality was 76.9% compared to a 100% when i nitiated in more advanced stages) (p < 0.001). Logistic regression analysis showed that ARF severity and haemodynamic failure were related with mortal ity. CONCLUSION: ARF is a frequent and early complication of SAP, worsening its prognosis. FRA severity is related to the outcome. Need of replacement ther apy supposes a high mortality. In this setting, HF seems to have advantages over conventional dialysis.