Analysis of fatal outcomes in acute pancreatitis

Objective. To identify the leading factors involved in the formation of adverse outcomes in the early phase of acute necrotizing pancreatitis (ANP) and to determine possible promising ways to influence them at the hospital stage.
Materials and methods. To identify the dynamics in the structure of causes of death and factors associated with fatal outcomes, the results of pathological studies of those who died due to ANP in the periods from 2010 to 2012 (n = 151) and from 2018 to 2021 (n = 164) were comparatively analysed.
Results. In ANP, adverse outcomes within 2 weeks of onset were 1.4 times more common in both comparison groups than at later stages (p = 0.003). Widespread pancreatic necrosis (PN) was observed in the vast majority of cases (96 % and 89 %, respectively) among patients who died in the comparison periods. However, isolated lesions of only one part of the pancreas were three times more common between 2018 and 2021 (p = 0.019), indicating a closer association between adverse outcomes and not only the extent of PN, but also other extrapancreatic lesions. Damage to the parapancreatic and retroperitoneal tissue was observed in the majority of deceased (98.4 %), the pathological process was predominantly widespread (63.2 %), while the overall incidence of parapancreatitis in 2018– 2021 became significantly higher compared to 2010–2012 (p = 0.018). In patients who died due to ANP, infected formations of various localizations were detected 1.7 times more often in 2018–2021 compared to 2010–2012 (124 and 72 cases, respectively; p = 0.028), with infected fluid collections most consistently (34.2 %) localized in the omental bursa; in recent years, their number has increased 4.6 times (55 and 12 cases, respectively; p = 0.001), and infection of fluid collections of this localization within 2 weeks from the onset of ANP occurred significantly more often than in 2010–2012 (16 and 4 cases, respectively; p = 0.001). In most cultures of sectional material, hospital flora was found, and intestinal flora was sown an order of magnitude less often (75 and 12 cases, respectively; p = 0.001). Of the 75 cases of contamination before death, 63 deaths (84 %) were operated on, a direct correlation was revealed between these signs (p = 0.049). The immediate cause of death in ANP in the majority of cases (219 (69.5 %) deaths) was multiple organ failure syndrome. In those who died in the early phase of ANP in 2018–2021, pathological lesions of the kidneys (91.7 %, p = 0.001), brain (89.6 %, p = 0.001), and liver (81.3 %, p = 0.001) became significantly more common.
Conclusion. A comparative analysis of the results of pathological examinations of patients who died due to ANP between 2010– 2012 and 2018–2021 revealed the dynamics of the main factors associated with adverse outcomes that should be addressed through medical interventions and the development and implementation of new, meaningful, and effective approaches at the early stage of the disease.

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