Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected

Jorge D. Machicado, Amir Gougol, Xiaoqing Tan, Xiaotian Gao, Pedram Paragomi, Ioannis Pothoulakis, Rupjyoti Talukdar, Rakesh Kochhar, Mahesh K. Goenka, Aiste Gulla, Jose A. Gonzalez, Vikesh K. Singh, Miguel Ferreira, Tyler Stevens, Sorin T. Barbu, Haq Nawaz, Silvia C. Gutierrez, Narcis O. Zarnescu, Gabriele Capurso, Jeffrey J. EaslerKonstantinos Triantafyllou, Mario Pelaez‐luna, Shyam Thakkar, Carlos Ocampo, Enrique de-Madaria, Gregory A. Cote, Bechien U. Wu, Darwin L. Conwell, Phil A. Hart, Gong Tang, Georgios I. Papachristou

Research output: Contribution to journalArticlepeer-review


Background: Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. Objective: We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. Methods: We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders. Results: 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3–34.9) and three (48%, OR = 20.2, 5.9–68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality. Conclusion: In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.

Original languageEnglish (US)
Article numberUEG212057
Pages (from-to)139-149
Number of pages11
JournalUnited European Gastroenterology Journal
Issue number2
StatePublished - Mar 2021
Externally publishedYes


  • acute pancreatitis
  • mortality
  • natural history
  • organ failure
  • systemic inflammatory response syndrome, severe acute pancreatitis

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology


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