Original articleRole of Early Multisystem Organ Failure as Major Risk Factor for Pancreatic Infections and Death in Severe Acute Pancreatitis
Section snippets
Patients
A total of 1520 patients with acute pancreatitis were treated at the Department of General Surgery, University Hospital of Ulm, Germany, between May 1982 and May 2001. There were 1128 patients with interstitial edematous and 392 patients with computed tomography and/or intraoperatively proven necrotizing pancreatitis. In 107 patients treatment was nonoperative, 96 had sterile necrosis (mortality, 7.3%), and 11 patients had fine-needle aspiration (FNA)–proven infection of necrosis (mortality,
Postoperative Infection Subgroups, Biologic Data, Etiology
After necrosectomy for sterile necrosis, 64 patients (47%) developed secondary PIN (group I), 37 patients (27%) had contaminations (group II), and 34 patients (25%) remained sterile (group III) throughout the course of the disease. Group I comprised 37 men and 27 women with a median age of 52 years (range, 18–82 years); group II consisted of 26 men and 11 women with a median age of 48 years (range, 22–87 years); and group III comprised 22 men and 12 women with a median age of 48 years (range,
Discussion
There are 2 major findings of the present study that question our general understanding of the prognostic role and the underlying pathomechanisms of pancreatic infections. First, early MODS seems to be an important pathomechanism of subsequent pancreatic infections and is a major risk factor of death. Second, bacterial invasion of pancreatic necrosis is of less prognostic importance than previously believed.
According to our current knowledge, the development of infected necrosis/pancreatic
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