THE DEVELOPMENT OF EARLY ORGAN FAILURE IN NECROTISING ACUTE PANCREATITIS

Aims. The study was aimed at the correlation of the development of early organ failure with the necrotising lesion of the pancreas and the prevalence of peripancreatic infiltration. Materials and methods. The treatment data of 1,550 patients with acute pancreatitis were analysed. The pancreatic lesion characteristics were evaluated by dynamic ultrasound and CT angiography in the third week of the disease. The conclusion on the presence of signs of organ failure was based on the international guidelines (more than 2 points on the SOFA scale). Results. In 85.61%, acute pancreatitis was not accompanied by the development of necrotic lesion of the pancreas. In 88.99% of cases of interstitial oedema of the pancreas, there was no peripancreatic infiltration. The formation of peripancreatic infiltration in the absence of symptoms of necrotising lesion of the pancreas is a poor prognostic sign. A microfocal lesion was observed in 7.48% of patients, in these, infiltration of up to 3 regions of the retroperitoneal cellular tissue was detected in 42.25% of cases, and of 4 to 6 regions – in 27.59%. Macrofocal necrosis was noted in 5.74% of them, and in 40.44% of cases, was accompanied by involvement of 4 to 6 regions of the cellular tissue in the pathological process. Subtotal lesion in less than 1% of cases was accompanied by a massive infiltration of the cellular tissue, 7 or more anatomical regions in 46.15%. Most often, complications on the part of cardiovascular system developed in phase I – 28.08% of severe acute pancreatitis. The development of multiple organ failure accompanies 48.82% of patients with severe course of the disease. The development of organ failure was not detected in interstitial oedema of the pancreas. Microfocal lesion was accompanied by complications in 41.38% of cases, while macrofocal – in 92.13%, and pancreatic damage with more than 50% of the volume always caused organ dysfunction.


INTRODUCTION.
Early organ failure in patients with necrotizing pancreatitis is an acute issue not only in urgent surgery but also in resuscitation science. Phase I of severe acute pancreatitis (SAP) is characterized by a "mediator hurricane" and is often associated with severe general complications that require complex treatment in the conditions of the intensive care department [1][2][3]. Patients with SAP have a high rate of lethality. It should be highlighted that 40% of lethal outcomes result from the development of early organ failure [4][5][6].
The clinical development of acute pancreatitis reflects the pathological process in the pancreas and retroperitoneum [7][8][9]. Thus, the evaluation of the extent and depth of the pancreas damage is the primary task in the diagnostics of acute necrotizing pancreatitis as one of the most severe forms of the disease.
The aim of the study was to evaluate the association between the development of early organ failure and the character of the necrotizing process in the pancreas and the extent of peripancreatic infiltrate.

MATERIALS AND METHODS.
The prospective clinical observation included 1550 patients with acute pancreatitis that were An increase in the threshold by 2 points by the SOFA scale indicates a dysfunction of the organ system.
In the present study, the general lethality rate was 2.58% (40 patients). In 24 patients (60%), the lethal outcome resulted from purulo-necrotic complications. In 16 cases (40%), the lethal outcomes occurred during phase I of acute necrotizing pancreatitis and were caused by severe systemic complications: pancreatogenic shock in 10 cases and development and progressing of early organ failure in 6 cases.
The statistical processing of the data was performed with the software package Statistica 6.1.
The obtained results are presented in absolute and relative values. The conclusion on the association between certain symptoms is based on the single-factor correlation analysis of Spearman, Gamma and Kendall's tau coefficients.
The study protocol followed guidelines for experimental investigation with human subjects in accordance with the Declaration of Helsinki and was approved by the ethics committee. Written informed consent was obtained from each patient (or official representative) before the study.

RESULTS.
In 85.61% (1327)  Subtotal damage of the pancreas was diagnosed in 0.84% (13) of cases and, in 46.15% of cases; it was associated with peripancreatic infiltrate extending to 7 and more anatomic areas. Total damage of the pancreas was observed in 0.32% (5) of cases. The involvement of the retroperitoneum fat in the pathological process was revealed in 100% of cases (Table 1).  There were no cases of organ failure revealed in patients with interstitial edematous pancreatitis. Fine-focal damage of the pancreas was associated with complications in 41.38% of cases, macrofocalin 92.13% of cases, and the extent of damage of more than 50% of the pancreas always caused the development of organ dysfunction (Table 3).  The early organ failure, which is an acute surgical and intensive care issue [9].

CONCLUSIONS.
The risk of the development of early organ failure in patients with SAE phase I increases in cases of a greater extent of the pancreas damage and the involvement of more than 3 areas of retroperitoneum fat into the pathological process.

FINANCIAL SUPPORT AND SPONSORSHIP
Nil.