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Abstract
Acute pancreatitis may be associated with both local and systemic complications. Systemic
injury manifests in the form of organ failure which is seen in approximately 20% of
all cases of acute pancreatitis and defines ‘severe acute pancreatitis’. Organ failure
typically develops early in the course of acute pancreatitis, but may also develop
later due to infected pancreatic necrosis induced sepsis. Organ failure is the most
important determinant of outcome in acute pancreatitis. We review here the current
understanding of the risk factors, pathophysiology, timing, impact on outcome and
therapy of organ failure in acute pancreatitis. As we discuss the pathophysiology
of severe systemic injury, the distinctions between markers and mediators of severity
are highlighted based on evidence supporting their causality in organ failure. Emphasis
is placed on clinically relevant end points of organ failure and the mechanisms underlying
the pathophysiological perturbations, which offer insight into potential therapeutic
targets to treat.