Organ Failure due to Systemic Injury in Acute Pancreatitis

Address for correspondence: Pramod K. Garg, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 
India., [e-mail] Or Vijay P. Singh, Department of Medicine, Mayo Clinic, Arizona, USA, [e-mail].
*Both the authors contributed equally to the work
Conflict of interest: None of the authors have any conflict of interest.
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Author manuscript
Gastroenterology
. Author manuscript; available in PMC 2020 May 01.
Published in final edited form as:
Gastroenterology. 2019 May ; 156(7): 2008–2023. doi:10.1053/j.gastro.2018.12.041.
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Systemic inflammation presents initially as systemic inflammatory response syndrome 
(SIRS). Patients with persistent SIRS are prone to develop systemic organ dysfunction and 
later organ failure (OF)
4, 5
. OF can develop either due to involvement of a particular organ 
system by a primary disease process or due to systemic effects of injury/inflammation at 
another site. Acute respiratory failure due to severe pneumonia is an example of the former 
and OF due to AP is an example of the latter. The most common cause of OF in clinical 
practice is sepsis. However, OF can develop due to non-infectious etiologies as well: AP and 
trauma are prime examples. OF is a 
conditio sine quo non of severe acute pancreatitis (SAP). 
SAP is defined by the presence of persistent OF as per the revised Atlanta classification of 
severity of AP.
2
OF largely governs the outcome and mortality in patients with AP, and 
therefore it is important to understand its epidemiology, risk factors, pathophysiology, 
potential mediators, impact on outcome and management. This review focuses on relevant 
pathophysiological and clinical aspects of OF in patients with AP and identifies unmet 
needs.