Článek

Introduction:
Fulminant acute (FAP) and subfulminant pancreatitis (SFAP) represent the latterly defined subgroup within the severe acute pancreatitis (SAP) with rapidly progressing organ failure (OF) and multi-organ failure MOF high level of lethality and poor effect of both conservative and surgical treatment.

Aim and Methods:
Analysis of indigenous set of patients diagnosed with SAP, particularly with FAP and SFAP, and comparison of data with the literature. Retrospectively prospective study of data collected over the period 2003 to 2007.

Results:
Mild form of AP (MAP) 128 p., etiology %: biliary/alcohol/other – 52/36/12; SAP 106 p., etiology %: biliary/alcohol/other – 51/41/9; ESAP 21 p. i.e. 20 % of SAP, aetiology %: biliary/alcohol/other – 3/27/39. Age: MAP/SAP/ESAP – 43.2/45.8/46.1. Lethality %: MAP/SAP/ESAP: 0/19/71.5 % (i.e. 78.5 % of all deaths of TAP. ESAP 21 p., FAP 6 p., SFAP 15 p. FAP/SFAP: M/F 3/3 or 11/4, age 44.5 (17-81) or 46.8 (25-73). FAP etiology: 1x biliary, 1x alcohol, 4x ?; SFAP: 6x biliary, 5x alcohol, 4x ?. FAP: 4x severe hypercholesterolemia or hypertriglyceridemia, SFAP dtto 3x. FAP lethality: 83%, SFAP: 67%. Mean survival rate: FAP 4.1 d., SAP 9.2 d. FAP treatment: conservative 3 p., surgical 3 p., hemoelimination 2 p. SFAP treatment: conservative 9 p., surgical 6 p (reoperated 92% of all surgically treated, 7x on average), hemoelimination 8 p.

Discussion:
Mortality prediction especially in FAP and SAP – progression and early occurrence of organ failure and its dynamics, existence of organ failure at the time of patient’s admission and its rapid deterioration. Action of age, comorbidity and aetiology: insufficient data for meta-analysis; difference between ESAP and LAP has no statistic importance. Indigenous set of patients proves incidence, progression and lethality in FAP and SFAP, demonstrates higher incidence of hyperlididemia and hypercholesterolemia in FAP (60%) compared to SFAP with far more frequent biliary or alcohol aetiology. Among FAP, SAP and LSAP no age-dependent differences were proved. Absolute dominance of organ failure symptoms, suspicion to infected necrosis rather rarely expressed. Differences in prognosis in relation to applied treatment – either conservative or surgical (FAP surgery 50%, SFAP surgery 60%) were not observed. In section severe destructive findings in pancreas and its vicinity as well as extensive organ lesions were observed.

Conclusion:
Our own results are in concord with the results of other studies. It appears pretty useful to search for further ESAP predicting factors within meta-analytical studies. Intensive resuscitation care since the admission is a necessity, despite that, particularly in FAP, the results are unfavourable; surgical treatment has higher impact in SFAP than in AP, where often is ultimum refugium only.

Key words:
acute pancreatitis – fulminant acute pancreatitis