Gordon Young Organ Pdf 20
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In patients with persistent organ failure, early aggressive treatment strategies are recommended to decrease mortality [110]. In addition, early surgical intervention is recommended in patients with severe AP and persistent organ failure. However, a recent article [111] analyzing data from the APNETS found no benefit of early surgical intervention, early endoscopic necrosectomy, or early percutaneous drainage on the risk of death or infection. Although the use of an aggressive strategy increased the risk of pancreatic infection (odds ratio 1.4), the authors stated that early intervention is not a valid option to reduce mortality. Many studies have demonstrated that the use of systemic antibiotics and the timing of surgical intervention are associated with mortality [112,113,114]. It is generally accepted that the use of systemic antibiotics can prevent mortality in critically ill patients and may decrease new-onset organ failure [115].
In patients with severe AP, early surgical or endoscopic necrosectomy is recommended in the absence of signs of organ failure (e.g., altered mental status, hypotension, tachycardia, and hypothermia). These patients should be managed in the ICU [2, 106, 118].
The rate of mortality is usually higher in elderly patients and those with chronic diseases, abnormal vital signs (ie, low heart rate, high respiratory rate, low blood pressure, and high oxygen requirement), low serum calcium, hypocalcemia, hypokalemia, and preexisting renal insufficiency. The presence of necrosis, which occurs in 20% to 30% of patients, is associated with a twofold increased risk of mortality. In contrast, biliary tract obstruction, which occurs in about 5% of patients, increases the chance of survival by at least 50%. The presence of AP in women, in patients with chronic alcohol consumption, and in patients with chronic illness seems to be associated with a higher mortality. Patients with a serum creatinine over 1.5 mg/dL have a higher mortality rate. The presence of infected necrosis increases the risk of death. The presence of pancreatic malignancy can be associated with a poorer outcome, with a fivefold increase in mortality rate. Finally, the current version of the RAC is used to predict mortality. However, the association of pancreatic pathologies and organ failures with the clinical course and outcome of AP must be discussed further.
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