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We read with great interest the recent Gut publication by Schepers et al 1 reporting no association between the time of onset or duration of persistent organ failure (POF, >48 hours, distinguished from transient organ failure <48 hours) and mortality in a subset of patients (240/639) with acute pancreatitis (AP). Previously it has been proposed that there are two peaks of POF and mortality in patients with AP, namely the early phase (first week) accompanied by persistent systemic inflammatory response syndrome and late phase (>second week) caused by infected pancreatic necrosis (IPN).2 Patients with early fulminant POF have been considered to have a higher mortality than those developing POF later,3–6 and those with POF in combination with IPN to have a higher mortality than those with POF alone.7 The findings from Schepers et al 1 have challenged these views but require confirmation. We have determined whether their findings are applicable to our AP patient populations.
We analysed 2145 and 939 patients with AP from retrospective (single centre) and prospective cohorts (multicentre), respectively, who were admitted ≤48 hours of symptoms onset (online supplementary table 1). There were 469 (21.9%) and 132 (14.1%) patients …
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