Organ Failure due to Systemic Injury in Acute Pancreatitis

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Organ Failure due to Systemic Injury in Acute Pancreatitis
Pramod K. Garg, M.D.
*
and
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Vijay P. Singh, M.D.
*
Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
Abstract
Acute pancreatitis may be associated with both local and systemic complications. Systemic injury 
manifests in the form of organ failure which is seen in approximately 20% of all cases of acute 
pancreatitis and defines ‘severe acute pancreatitis’. Organ failure typically develops early in the 
course of acute pancreatitis, but may also develop later due to infected pancreatic necrosis induced 
sepsis. Organ failure is the most important determinant of outcome in acute pancreatitis. We 
review here the current understanding of the risk factors, pathophysiology, timing, impact on 
outcome and therapy of organ failure in acute pancreatitis. As we discuss the pathophysiology of 
severe systemic injury, the distinctions between markers and mediators of severity are highlighted 
based on evidence supporting their causality in organ failure. Emphasis is placed on clinically 
relevant end points of organ failure and the mechanisms underlying the pathophysiological 
perturbations, which offer insight into potential therapeutic targets to treat.
Keywords
Acute pancreatitis; Organ failure; Pathophysiology
Acute pancreatitis (AP) causes major morbidity and mortality. According to global 
estimates, the incidence of AP was shown to be 33·74 cases (95% CI 23·33-48·81) per 100 
000 person-years and a mortality of 1·60 (95% CI 0·85-1·58) per 100 000 person-years due 
to AP.
1
The severity of AP can either be mild, moderate or severe, which depends on the 
extent of local injury in and around the pancreas, and more importantly systemic injury to 
remote organs.
2
Mild AP has no major local or systemic complications. More severe form of 
the disease seen in around 20% of all patients with AP is associated with significant local 
complications in the form of necrosis and often systemic injury due to systemic 
inflammation.
3