New-onset persistent organ failure predicts adverse outcomes in patients with severe acute pancreatitis

BACKGROUND Organ failure (OF) is a frequent and critical feature of severe acute pancreatitis (SAP). However, the association between OF patterns and mortality is still a subject of debate. AIM To compare the clinical profiles of SAP cases with and without new-onset OF (NOOF) and identify adverse outcome predictors. METHODS We conducted a retrospective cohort study of patients with SAP at a tertiary referral hospital to assess OF patterns. Based on the observed OF episodes, the cohort was categorized into OF (n = 113) and NOOF (n = 38) groups, with the latter further subdivided into new-onset single OF (n = 17) and new-onset multi-OF (n = 21). Independent predictors of mortality were identified through multivariable logistic regression and Cox proportional-hazards models. RESULTS Significant differences were observed between the OF and NOOF groups in clinical severity and adverse outcomes, characterized by prolonged OF, extended organ support, and increased hospital length of stay. Binary logistic regression revealed significant associations with major complications [odds ratio (OR) = 13.2, 95% confidence interval (CI): 2.1-83.5, P = 0.006], NOOF (OR = 7.4, 95%CI: 1.3-42.5, P = 0.024), and Bedside Index for Severity in Acute Pancreatitis score (OR = 4.0, 95%CI: 1.3-12.0, P = 0.013). The 90-day mortality Cox proportional-hazards regression showed similar results [new-onset single OF hazard ratio (HR) = 6.8, 95%CI: 1.4-33.5, P = 0.019; new-onset multi-OF HR = 33.2, 95%CI: 9.4-117.3, P < 0.001; Bedside Index for Severity in Acute Pancreatitis score HR = 2.5, 95%CI: 1.3-4.6, P = 0.005]. CONCLUSION New-onset persistent OF, particularly multi-OF, substantially increases mortality after multivariable adjustment in patients with SAP, highlighting the need for further investigation.