Managing Organ Failure in Acute Pancreatitis

Organ failure (OF) is the key determinant of mortality in patients with acute pancreatitis (AP) and is the key criterion for grading the severity of AP. Previously, it was considered that OF and infected pancreatic necrosis (IPN) were equivalent determinants of mortality, but there has been considerable progress in the management of IPN, including drainage-first strategy and a step-up approach to laparoscopic and endoscopic necrosectomy. This has resulted in a decreased incidence of new-onset OF and mortality compared with open surgical necrosectomy, which means that OF is the most important determinant of severity and mortality, while IPN is still associated with increased morbidity but has less impact on mortality.