Resumo

DIAZ, Catalina; GARZON, Sandra; MORALES, Carlos H  e  MONTOYA, Marcela. Severe acute pancreatitis: Clinical course, management, and mortality-associated factors. rev. colomb. cir. [online]. 2012, vol.27, n.4, pp.281-289. ISSN 2011-7582.

Objective. To describe the clinical course of patients with acute pancreatitis at a four level of care medical center and to explore mortality-associated factors. Material and methods. Retrospective study of cohorts of 71 episodes of pancreatitis fulfilling the Atlanta 1992 international consensus severe acute pancreatitis criteria. Demographic information, severity factors, surgical and medical management, complications and mortality rate were evaluated. Results. Severe acute pancreatitis represented 42.7% of the diagnoses of acute pancreatitis, one of the highest figures in the world literature. Upon admission, patients presented Ranson criteria of 1.9 (standard deviation, SD, 1.7), APACHE II index of 2.1 (SD, 5.8), and Tomography Severity Index of 3.5. Intensive care unit care was required by 29% of patients, and 50% demanded mechanical respiratory support; 52% required vasopressor hemodynamic support; 82% received enteral nutrition; 45% were submitted to surgery. Mortality rate was 32.4%, a value higher than the reported world scientific literature. Related mortality risk factors were organ failure upon admission, hemodialysis requirement, mechanical ventilatory support requirement, and use of vasopressor agents on admission to the ICU and during the first 48 hours. In the multivariate analysis, the use of vasopressor agents appeared as an independent mortality risk factor. Conclusion. Patients with severe acute pancreatitis demand an early diagnosis in oprder to receive prompt and efficient care, which includes enteral nutrition. Mortality is related with the early requirement of advanced vital support for their organ failure.

Palavras-chave : pancreatitis; acute; risk factors; complications; mortality.

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