Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality

BACKGROUND: Risk stratification of acute pancreatitis (AP) is important. OBJECTIVE: To characterize patients with early severe pancreatitis, identify risk factors of severity, and assess their outcome. METHODS: All consecutive patients with AP were included in the study. Severity assessment was done by APACHE II score, and presence and intensity of organ failure (OF). OF was graded from 1 to 4. Patients with severe pancreatitis were divided into early severe and late severe AP. The criterion for early severe AP (ESAP) was severe OF within 7 days of pancreatitis. Patients with ESAP were subdivided into fulminant and subfulminant AP based on timing of OF, i.e., < 72 h and between 4 and 7 days of pancreatitis, respectively. RESULTS: Of 282 patients with AP, 144 (51%) had mild AP, 32 (11.34%) had ESAP, and 106 (37.58%) had late severe AP. Of the ESAP patients (mean age 45.4 yr, 22 men), 10 patients had fulminant AP and 22 had subfulminant AP. Patients with ESAP had higher admission APACHE II compared to patients with late severe AP (14.9 vs 8.8, P < 0.001). The proportion of patients with multiorgan failure was significantly higher in ESAP compared with late severe AP (75% vs 26%, P < 0.001). The difference in mortality was significant in the fulminant, subfulminant, and late severe AP (90%, 72.7%, and 30%; P < 0.001). Patients with ESAP accounted for 44% of all deaths. Predictors of mortality were development and early onset of organ failure. CONCLUSIONS: We have characterized newer subgroups of patients with fulminant and subfulminant AP with important prognostic and management implications.