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01 September 1998

Acute renal failure in patients with acute necrotizing pancreatitis and multiple organ failure

M‡aria Tarj‡anyi, Katalin Darvas, Zolt‡an Va‡mos, Piroska Antony-Mo—reŽ, Tibor F. Tihanyi, Lajos E. Flautner

Med Sci Monit 1998; 4(5): CR780-785 :: ID: 501972

Abstract

Background:Acute renal failure (ARF) is not a rare complication of acute necrotizing pancreatitis with multiple organ failure (MOF), nor of the multiple organ dysfunction syndrome (MODS).
Material/Methods: We studied a group of 44 patients with the MOF syndrome induced by acute necrotizing pancreatitis: 30 patients had ARF. Out of these 30 (68%) ARF patients, we evaluated three scoring systems: APACHE II scores were determined during admission and MOF scores were evaluated daily in each case according to Goris. Ranson scores were evaluated in the first 48 hours in 7 patients. Among these patients, 15 required hemodialysis while the others received conservative therapy. Microbiological samples, CRP and other laboratory tests were analysed.
Results: The survival rate of ARF patients (MOF and acute necrotizing pancreatitis) requiring hemodialysis amounted up to 13 %. The origin of MOF and ARF being mostly sepsis and septic shock. MOF survivor points were 6.6 (5-9) while those of non-survivors 9.9 (7-14). All patients had respiratory failure. Ranson survivor scores were 2.6 and those of non-survivors 4.7. As for the APACHE II scores survivors had 14.3 (5-21), and the non-survivors 16.6 (4-31) points. We noted the fact that patients with more than 25 points died. There was no difference between the number of operations: survivors had 3.2 (1-8) while non-survivors 3 (1-8) operations. Surgical interventions amounted mostly to the removal of all necrotic tissue around the pancreas and lavage. There was no difference in the mean number of hemodialysis between the survivors (7) and non-survivors (6.4). Histology performed at autopsy showed either tubular necrosis or glomerular necrosis. Bacteria responsible for septic complications were as follows: Streptococcus, Pseudomonas, Staphylococcus and Candida albicans.
Conclusions:The prognosis of a patient with ARF is poor. We think that an adequate operation performed at the proper time as well as early dialysis treatment are needed to improve the survival rate. APACHE II scores did not predict the development of the MOF syndrome in patients with acute pancreatitis.

Keywords: acute renal failure, Multiple Organ Failure, Multiple Organ Dysfunction Syndrome, acute necrotizing pancreatitis, Surgery, hemodialysis

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750