Risk Factors for Acute Fulminant Pancreatitis in Patients Admitted to the Intensive Care Unit: A Retrospective Study

Background/Objectives The term acute fulminant pancreatitis (AFP) has been proposed to define the most severely ill patients and those who are likely to die before they develop persistent organ failure. The objective of our study was to determine the risk factors for developing AFP in patients admitted to the intensive care unit (ICU). Methods This was a retrospective study conducted between January 2007 and May 2019 in a ICU. Patients ≥18 years old admitted to the ICU within 3 days of the onset of abdominal pain related to acute pancreatitis were included. We defined AFP according to the modified Marshall scoring system for organ dysfunction based on a score ≥ 2 involving at least 2 organ systems for at least 48 hours or ≤ 48 hours if the patient died during the first 7 days of hospitalization. Results Sixty-three patients were analyzed (AFP group, n=27 - non-AFP group, n=36). In multivariate analysis, AFP was associated with a lower level of fluid loading before ICU admission (OR [95%CI] = 0.89 [0.82; 0.97], p<0.001) and a higher modified Marshall score (OR [95%CI] = 2.31 [1.53; 3.49], p<0.001). On day 7, mortality was higher in the AFP group (48% vs. 3%, p<0.001), and 29% of patients with AFP died within 48 hours of admission to the ICU before developing persistent organ failure. Conclusions A lower level of fluid resuscitation prior to admission to the ICU and a higher modified Marshall score on ICU admission were independently associated with higher risks of developing AFP.