Early severe acute pancreatitis: Characteristics of a new subgroup

This study focuses on patients with severe acute pancreatitis complicated b y organ failure within the initial phase of the disease. Data of 158 patien ts with severe acute pancreatitis (SAP) admitted to hospital within 72 hour s after onset of symptoms were prospectively documented and analyzed for th e occurrence of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ failure (OF) at admission. Forty-seven (30%) patients ha d ESAP, compared with ill patients without OF (SAP group). in a multivariat e analysis, the main factor predisposing to ESAP was the presence of extend ed pancreatic necrosis (odds ratio, 3.8), whereas biliary pancreatitis was associated with a slightly lower risk compared with alcoholic pancreatitis (odds ratio, 0.34). Compared with SAP, patients with ESAP more frequently d eveloped intractable organ failure, which posed the indication for surgical treatment. Surgical necrosectomy due to progressive OF had to be performed in 89% of the ESAP patients and in 60% of the SAP patients. The incidence of infected pancreatic necrosis did not differ between both groups (23 vs. 21%). Mortality was significantly higher in ESAP (42 vs. 14%; p = 0.0003). ESAP is characterized by the presence of extended pancreatic necrosis and a complicated clinical course. Intractable organ failure is a frequent findi ng. Given the poor prognosis of ESAP, these patients should be treated in s pecialized intensive care units.