DETERMINATION OF GRADE OF GASTROINTESTINAL INJURY AND ITS PROGNOSTIC UTILITY IN PATIENTS WITH ACUTE NECROTIZING PANCREATITIS

Acute necrotizing pancreatitis (ANP) is potentially lethal inflammatory process. Recent researches established that presence of multiorgan failure together with pancreatic infection are major determinants of its mortality. But significance of acute gastrointestinal injury (AGI) in course of ANP is still remaining unclear. Aim: To determine frequency and significance of AGI on severity and mortality of ANP. Material and methods: We performed a prospective observational cohort study of 151 patients with ANP which were admitted to single intensive care department. AGI was established according to European Society of Intensive Care Medicine (ESICM) recommendations. Clinical and laboratorial variables as well as plasma citrulline concentrations were studied. Results: Persistent organ failure was diagnosed in 33% and transient in 67% observations. Respiratory failure has been dominated in mortality structure, cardiovascular, renal and intestinal failures were met with equal frequency. Serum citrulline concentration reflected the level of AGI. Conclusions:  Intestinal failure is strongly associated with unfavorable events in patients with acute necrotizing pancreatitis as well as pulmonary, cardiovascular and renal dysfunctions. Plasma citrulline concentration is simple and reliable marker for diagnosing and monitoring AGI.