Organ Failure due to Systemic Injury in Acute Pancreatitis

particularly those with very early onset high-
grade single OF or multi-organ failure termed as fulminant pancreatitis.
19, 31
The mortality due to OF is high even after the first 2 weeks. Patients with persistent OF who 
survive the first 2 weeks are prone to develop infected necrosis, which accounts for the late 
mortality. In a French study of 148 patients, 40 of 53 (75%) patients with persistent OF 
developed infected pancreatic necrosis (IPN).
41
In another study, 76% of patients with 
persistent OF developed IPN after they survived the first 2 weeks.
9
Hypotension in the first 
week of AP was an independent risk factor for IPN.
42
There is not much difference between 
mortality due to early onset OF and late onset OF (Table 2) Two recent studies have focused 
attention on the issue of timing of onset of OF and outcome in AP. In a study of 614 patients, 
early onset primary OF resulted in early mortality in 15.8% of patients and a further 42.8% 
late mortality due to development of infected necrosis.
9
In a Dutch study of 639 patients, 
219 patients with persistent OF had a mortality of 38%. Mortality was not related to timing 
of onset of persistent OF. Mortality due to persistent OF developing within the first week, 
1-2 weeks, 2-3 weeks and >3 weeks from the onset was 42%, 46%, 36% and 29% 
respectively in that study.
10
Patients with OF and IPN have a high mortality termed ‘critical 
AP’ according to the Determinant based classification.
43
But the data are inconsistent as to 
whether they have a higher mortality than those with early persistent OF without IPN. In the 
Dutch study, similar mortality rates were observed in patients with OF with and without IPN 
(28% vs. 34%, p=0.33) after excluding patients with mortality within 10 days of admission.
10
In summary, the progression of an early systemic inflammatory response to organ failure 
defines severe AP and is associated with a high risk of mortality. Development of infected 
necrosis later in the clinical course exacerbates the initial injury and worsens the outcome.