Mofidi R, Duff MD, Wigmore SJ, et al. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis

Department of Clinical and Surgical Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
British Journal of Surgery (Impact Factor: 5.54). 06/2006; 93(6):738-44. DOI: 10.1002/bjs.5290
Source: PubMed


Mortality in patients with acute pancreatitis is associated with the number of failing organs and the severity and reversibility of organ dysfunction. The aim of this study was to assess the significance of early systemic inflammatory response syndrome (SIRS) in the development of multiorgan dysfunction syndrome (MODS) and death from acute pancreatitis.
Data for all patients with a diagnosis of acute pancreatitis between January 2000 and December 2004 were reviewed. Serum C-reactive protein (CRP), Acute Physiology And Chronic Health Evaluation (APACHE) II scores and presence of SIRS were recorded on admission and at 48 h. Marshall organ dysfunction scores were calculated during the first week of presentation. Presence of SIRS and raised serum CRP levels on admission and at 48 h were correlated with the cumulative organ dysfunction scores in the first week.
A total of 759 patients with acute pancreatitis were identified, of whom 45 (5.9 per cent) died during the index admission. SIRS was identified in 162 patients on admission and was persistent in 138 at 48 h. The median (range) cumulative Marshall score in patients with persistent SIRS was significantly higher than that in patients in whom SIRS resolved and in those with no SIRS (4 (0-12), 3 (0-7) and 0 (0-9) respectively; P < 0.001). Thirty-five patients (25.4 per cent) with persistent SIRS died from acute pancreatitis, compared with six patients (8 per cent) with transient SIRS and four (0.7 per cent) without SIRS (P < 0.001). No correlation was observed between CRP level on admission and Marshall score (P = 0.810); however, there was a close correlation between CRP level at 48 h and Marshall score (P < 0.001).
Persistent SIRS is associated with MODS and death in patients with acute pancreatitis and is an early indicator of the likely severity of acute pancreatitis.

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    • "The exact mechanisms by which diverse etiological factors induce an attack are still unclear, while it is generally believed that the release of a variety of inflammatory mediators causes a cascadelike reaction and leads to systemic inflammatory response syndrome (SIRS). An excessive SIRS leads to distant organ damage and multiple organ dysfunction syndrome (MODS), which established the role played by inflammatory mediators in the aggravation of AP and the resultant fatal condition [3] [4] [5]. "
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    International journal of clinical and experimental pathology 08/2014; 7(7):3647-61. · 1.89 Impact Factor
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    • "About fifteen percent of the patients develop severe disease defined by development of persistent organ failure [1]. The mortality in acute pancreatitis is mainly associated with multiple organ failure [2] whereas the risk of dying is minimal in patients with no or transient organ dysfunction [3,4]. In acute pancreatitis, multiple organ failure is a consequence of excessive activation of a systemic inflammatory response cascade [5]. "
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    • "BISAP incorporates f ive parameters: blood urea nitrogen > 25 mg/dL, impaired mental status, systemic inflammatory response syndrome (SIRS), age > 60 years, and detection of pleural effusion by imaging [17,18]. SIRS is defined by the presence of at least two of the following: pulse > 90 beats per minute, respirations > 20 per minute, PaCO2 < 32 mmHg, temperature > 38℃ or < 37℃, and white blood cell count > 12,000 or < 4,000 cells/mm3, or > 10% immature neutrophils (bands) [19,20]. A prospective validation of the BISAP scoring system as a method for the early detection of severe AP was published recently, and concluded that it is a reliable, accurate means for stratifying patients with AP [17] and that it was an accurate and convenient method of risk stratification compared with other multifactorial scoring systems in patients with AP [21]. "
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