S285 Renal Failure Was the Most Common Organ Failure in a Cohort With Severe Acute Pancreatitis: Implications for Identification and Reversal of Persistent Organ Failure

Introduction: Acute pancreatitis (AP) can be mild, moderate or severe. Organ failure (OF) is classified as renal, respiratory and cardiovascular (shock). Moderately severe AP has transient organ failure and severe AP has organ failure >48 hours and is associated with increased morbidity and mortality as high as 30% and presents with infected pancreas necrosis and systemic complications. It is not clear which OF is more common. We studied a large database to determine the more salient OF in patients with moderate to severe AP. Methods: The TriNetX database a multinational real time repository was queried from 2014 to 2025. ICD-10 codes were used to diagnose AP, renal, respiratory, and cardiovascular OF. Moderate severe to severe AP (SAP) was grouped as SAP as it was not possible to determine the duration of OF. Exclusion criteria were a previous diagnosis of chronic pancreatitis, previous pancreas surgery, and others. Variables including weight, smoking and alcohol use were compared using Wilcoxon rank sums and Kruskal-Wallis tests. Propensity score matching was then performed. Percentages and odds ratio were reported. P < 0.001 was significant. Results: There were 2,880,662 subjects with SAP identified as having any of the 3 OF. Renal failure was identified in 60.3% (1,736,400 patients) of the cohort, respiratory failure in 53% (1,524,732 patients) and cardiovascular failure in 18% (51,636) of patients. Each OF was then studied in groups and not surprisingly, renal and respiratory failure comprised 96.8% of all the OF in this cohort. Conclusion: Some studies suggest that respiratory failure is the most significant OF in patients with SAP. Unfortunately, we were unable to differentiate between moderately severe and severe acute pancreatitis. However, this large database study found that renal failure was the most significant OF. This is important because it may be reversible, and correcting the OF in <48 hours has an impact on the morbidity and mortality associated with SAP. Further studies on early recognition and correction of OF and outcomes in SAP are needed.