Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2016; 8(7): 526-531
Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.526
Pancreatic injury in patients with septic shock: A literature review
Anis Chaari, Karim Abdel Hakim, Kamel Bousselmi, Mahmoud Etman, Mohamed El Bahr, Ahmed El Saka, Eman Hamza, Mohamed Ismail, Elsayed Mahmoud Khalil, Vipin Kauts, William Francis Casey
Anis Chaari, Karim Abdel Hakim, Kamel Bousselmi, Mahmoud Etman, Mohamed El Bahr, Ahmed El Saka, Eman Hamza, Mohamed Ismail, Elsayed Mahmoud Khalil, Vipin Kauts, William Francis Casey, Department of Intensive Care, King Hamed University Hospital, Al Muharaq 24343, Bahrain
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All the authors declare they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Anis Chaari, MD, Department of Intensive Care, King Hamed University Hospital, Bilding 234, Road 2835, Block 228, Bussaiteen, Al Muharaq 24343, Bahrain.
Telephone: +973-38073955 Fax: +973-17766428
Received: March 16, 2016
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.

Keywords: Septic shock, Pancreas, Lipase, Amylase, Prognosis

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.