Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
HPB (Oxford). 2009 Mar;11(2):166-70. doi: 10.1111/j.1477-2574.2009.00038.x.
Extrapancreatic organ dysfunction is the key determinant of mortality in acute pancreatitis (AP). This study aimed to document the frequency and duration of individual organ dysfunction in all fatalities caused by AP in a large, population-based cohort.
All deaths caused by AP in Scotland between 2000 and 2006 inclusive were analysed (n = 1024).
The median time lapse between the onset of AP and death was 6 days (interquartile range [IQR] 17 days); that between the onset of organ dysfunction and death was 3 days (IQR 7 days). There was no apparent bimodal distribution. The majority of patients had single- (384 patients) or two-system (242 patients) extrapancreatic organ dysfunction. Pulmonary dysfunction was most prevalent (30% of organ-specific entries, 198/660), followed by cardiovascular (18%, 117/660), renal (16%, 108/660), liver (11%, 71/660), gastrointestinal (9%, 59/660), haemorrhage (6%, 38/660), coagulopathy (5%, 31/660) and central nervous system (6%, 38/660) dysfunction.
Death in AP occurs early in the disease course. The present findings support the primacy of pulmonary injury as the modal pattern of organ dysfunction in severe AP, with increased frequencies of cardiovascular and renal compromise in fatal AP.
胰外器官功能障碍是急性胰腺炎（AP）患者死亡的关键决定因素。本研究旨在记录在一个大型基于人群的队列中所有由 AP 引起的死亡病例中，个体器官功能障碍的频率和持续时间。
分析了 2000 年至 2006 年期间苏格兰所有由 AP 引起的死亡病例（n=1024）。
AP 发病至死亡的中位时间间隔为 6 天（四分位间距 [IQR] 17 天）；器官功能障碍发病至死亡的中位时间间隔为 3 天（IQR 7 天）。没有明显的双峰分布。大多数患者仅有单一系统（384 例）或两个系统（242 例）胰外器官功能障碍。肺功能障碍最为常见（30%的器官特异性条目，198/660），其次是心血管功能障碍（18%，117/660）、肾功能障碍（16%，108/660）、肝功能障碍（11%，71/660）、胃肠道功能障碍（9%，59/660）、出血（6%，38/660）、凝血功能障碍（5%，31/660）和中枢神经系统（6%，38/660）功能障碍。
AP 患者的死亡发生在疾病早期。本研究结果支持肺损伤作为严重 AP 中器官功能障碍的主要模式，致命性 AP 中心血管和肾功能障碍的发生率增加。
