Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.526
Peer-review started: March 18, 2016
First decision: April 18, 2016
Revised: April 26, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: July 15, 2016
Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention.
Core tip: Pancreatic injury is common in septic shock patients. Tissue hypoperfusion is the main leading cause of pancreatic insult. Other factors such as oxidative stress and cellular apoptosis have been reported to enhance the pancreatic damage. The clinical relevance of increased level of pancreatic enzymes is not well established. In fact, hyperamylasemia and/or hyperlipasemia are not associated with higher mortality. Moreover, most of the imaging investigations do not show significant morphological changes of the pancreas. Hence, disturbed serum pancreatic enzymes without clinical evidence of acute pancreatitis should not trigger any specific therapy.