Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2014 Vol. 22 No 4

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.4.416   |  

O.A. KUDELICH1, G.G. KONDRATENKO1, O.A. YUDINA2, P.M. MOTOLYANETS3

MULTIVARIATE ANALYSIS OF FACTORS ASSOCIATED WITH IMMEDIATE CAUSES OF DEATH IN SEVERE ACUTE PANCREATITIS

EE Belarusian State Medical University1,
ME Minsk City Clinical pathoanatomical Bureau 2,
SE Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus 3,
The Republic of Belarus

Objectives. To reveal the most significant immediate causes of death at severe acute pancreatitis and determine the most important pathological changes in vital organs to develop the targeted method of protection.
Methods. A randomized analysis of pathoanatomical studies of deceased patients (n = 225) due to severe acute (and/or exacerbation of chronic) pancreatitis has been performed. Correlation analysis is used to determine the age and the period from the disease onset to lethal outcome.
Results. In the most cases the multiple organ dysfunction syndrome (MODS) in severe acute pancreatitis led to the immediate death in 165 cases (73,3%). Intoxication as the second most common cause of death was revealed in 27 cases (12%). In different age groups the immediate causes of death have been differed reliably (χ 2=22,8; =0,043) without any correlation between them (Spearmns r =-0,017; =0,795). Analysis of vital organ structural changes has revealed that pathologically significant lung damage was reported most commonly at severe acute pancreatitis (83,1%) in both age groups; the second most common lesion was cerebral tissue (70,2%), hereafter renal parenchyma (69,3%), myocardium (67,1%) and liver (54,2%). The reliable differences and correlation dependence of frequency of injury of cardiovascular (χ 2=8,35; =0,004/ r = 0.193; =0,004) and hepatic (χ 2=7,1; =0,008/ r=-0,178; =0,009) systems of different age groups have been detected.
Conclusions. The multiple organ dysfunction syndrome (MODS) due to endogenous intoxication in patients with severe acute pancreatitis is considered to be the main immediate cause of death (73.3%) irrespective of age and disease onset. Generalized microcirculatory disturbances being a reason of tissue hypoxia manifest rationality of compensation of energy deficit of cells and MODS prevention applying the agents providing hypoxia appeared to be independent of complex II of the respiratory chain.

Keywords: severe acute pancreatitis, immediate causes of death, endogenous intoxication, multiple organ dysfunction syndrome
p. 416 427 of the original issue
References
  1. Yadav D, Lowenfels AB.The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013 Jun;144(6):1252-61.
  2. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA Acute Pancreatitis Guidelines1. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15.
  3. Gomatos IP, Xiaodong X, Ghaneh P, Halloran C, Raraty M, Lane B, Sutton R, Neoptolemos JP.Prognostic markers in acute pancreatitis. Expert Rev Mol Diagn. 2014 Apr;14(3):33346.
  4. Ellis MP, French JJ, Charnley RM.Acute pancreatitis and the influence of socioeconomic deprivation. Br J Surg. 2009 Jan;96(1):7480.
  5. Iaitskii NA, Sedov VM, Sopiia RA. Ostryi pankreatit. Moscow, RF: MEDpress-inform, 2003. 224 p.
  6. Simon P. Young, BSc (Hons) MB ChB FRCA, Jonathan P. Thompson, BSc (Hons) MD FRCA Severe acute pancreatitis BJA: CEACCP Contin Educ Anaesth Crit Care Pain.2008;8(4):12528.
  7. Saenko VF, Desiaterik VI, Pertseva TA, Shapovaliuk VV. Sepsis i poliorgannaia nedostatochnost' [Sepsis and multiple organ failure]. Krivoi Rog, RF: Mineral, 2005. 466 p.
  8. Wig JD, Bharathy KG, Kochhar R, Yadav TD, Kudari AK, Doley RP, Gupta V, Babu YR.Correlates of organ failure in severe acute pancreatitis. JOP. 2009 May 18;10(3):27175.
  9. Nordback I, Paajanen H, Sand J. Prospective evaluation of a treatment protocol in patients with severe acute necrotising pancreatitis. Eur J Surg. 1997 May;163(5):35764.
  10. Mole DJ, Olabi B, Robinson V, Garden OJ, Parks RW.Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HPB (Oxford). 2009 Mar;11(2):16670. doi: 10.1111/j.1477-2574.2009.00038.x.
  11. Riabov GA. Gipoksiia kriticheskikh sostoianii [Hypoxia of critical states]. Moscow, RF: Meditsina; 1988. 288 p.
  12. Zaiko NN, Byts' IuV, red. Ataman AV. Patologicheskaia fiziologiia [Pathological physiology]. Moscow, RF: MEDpress-inform, 2006. 635 p.
  13. Zhidkov SA, Korik VE, Kliuiko DA, Titovets EP. Vozmozhnosti primeneniia priamoi oksimetrii dlia otsenki sostoianiia podzheludochnoi zhelezy pri ostrom pankreatite v eksperimente [Direct oximetry applying to assess the pancreas in acute pancreatitis in the experiment]. Novosti Khirurgii 2010; 3(18):916.
  14. Afanas'ev VV. Klinicheskaia farmakologiia reamberina [Clinical pharmacology of reamberin]. Saint-Petersburg, RF: 2005. 44 p.
  15. Kosinets VA. Vliianie preparata Reamberin, soderzhashchego iantarnuiu kislotu, na funktsional'nuiu aktivnost' mitokhondrii myshechnogo sloia tonkoi kishki pri rasprostranennom gnoinom peritonite [Effect of the drug "Reamberin" containing succinic acid, on the mitochondrial functional activity of small intestine muscular layer in generalized purulent peritonitis]. Novosti Khirurgii 2007;4(15):815.
Address for correspondence:
220116, Respublika Belarus, g. Minsk, pr. Dzerzhinskogo d. 83, UO Belorusskiy gosudarstvennyiy meditsinskiy universitet, 1-ya kafedra khirurgicheskih bolezney,
e-mail: kudelichsurg@gmail.com,
Kudelich Oleg Arkadevich
Information about the authors:
Kudelich O.A. A post-graduate student of the 1st chair of surgical diseases of EE Belarusian State Medical University.
Kondratenko G.G. MD, professor, a head of the 1st chair of surgical diseases of EE Belarusian State Medical University.
Yudina O.A. PhD, a head of the general pathology department of ME Minsk City Clinical Pathoanatomical Bureau.
Motolyanets P.M. A physician-pathologist of SE Republican Clinical Medical Center of the Presidential Administration of the Republic of Belarus.
Contacts | ©Vitebsk State Medical University, 2007