Significance of organ failure and comparison with prognostic indicator systems in acute pancreatitis

Acute pancreatitis is a a clinical situation that cause inflammatory effects in pancreatic region and afterwards systemically after activation of inactive digestive enzymes of pancreas gland due to various reasons. For many years severity and prognosis of acute pancreatitis is measured by Ranson and Atlanta classifications. Many studies demonstrate that pancreatitis induced organ failure, laboratory values and anthropometric characteristics of patients are associated with the severity and prognosis. In this study we evaluated the relationship between pancreatitis induced organ failure, laboratory values and anthropometric characteristics of patients and Ranson and Atlanta classification systems. In this study we evaluated 153 consecutive patients in the range 19 to 50 years who were followed in our clinic with the diagnosis of acute pancreatitis. The Ransom and Modified Atlanta scores were calculated, labaratory data, anthropometric data such as waist circumference, body mass index, clinical survey and organ failure were all recorded with daily visits for all patients. Organ failures (lung, liver, kidney, heart and multiorgan failure) in patients were associated with high scores of Ranson and modified Atlanta values (p <0.05). In 13 of patients (8.4%) multiorgan failure and in 17 (11.1%) SIRS have developed. Of these, 10 (6.5%) developed early SIRS, 7 of them developed SIRS in 48 hours after admission (late) and in 4 of 7 patients with late SIRS, it continued as persistent SIRS. In 10 patients (6.5%) exitus letalis occurred. Organ failure, multiorgan failure and SIRS were significantly associated with deaths with a p-value (p <0.05). There was no significant relationship between anthropometric measures of waist circumference, body mass index and Ranson's criteria, but on the other hand waist circumference was significantly correlated with the Modified Atlanta classification (p <0.01). Laboratory data of urea and ALT elevations were associated with Ranson and modified Atlanta classification (p <0.001). Of CRP values on 0 and 48th hours, only value of 48th hour was found to be associated with Ranson's criteria (p <0.05). Organ failure, MOF and SIRS were significantly correlated with both severity scores as well as mortality. Besides mortality was correlated with cholesterol, triglyceride and CRP levels at the time of admission but on the other hand there was no significant relationship between mortality and laboratory data such as calcium, lipase and hematocrit. As a result, in order to determine the prognosis, severity and organ failures in severe pancreatitis; beside classical severity scoring systems, body mass index, waist circumference and laboratory data such as cholesterol, triglyceride, ALT, CRP provide important prognostic information. Keywords: Acute pancreatitis, organ failure, severity scoring