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Year 2014 Vol. 22 No 4
GENERAL AND SPECIAL SURGERY
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 University”1,
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; ð=0,043) without any correlation between them (Spearmàn’s r =-0,017; ð=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; ð=0,004/ r = 0.193; ð=0,004) and hepatic (χ 2=7,1; ð=0,008/ r=-0,178; ð=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.
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220116, Respublika Belarus, g. Minsk, pr. Dzerzhinskogo d. 83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», 1-ya kafedra khirurgicheskih bolezney,
Kudelich Oleg Arkadevich
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”.