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

doi:10.3748/wjg.v32.i7.114773

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Feb 21, 2026; 32(7): 114773
Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.114773

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

Xue-Tao Zhang, Hao Zhu, Xian-Cheng Chen, Tao Gao, Ming Chen, Zhang-Hua Zhu, Bei-Yuan Zhang, Wen-Kui Yu

Xue-Tao Zhang, Xian-Cheng Chen, Tao Gao, Ming Chen, Zhang-Hua Zhu, Bei-Yuan Zhang, Wen-Kui Yu, Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China

Hao Zhu, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China

Co-first authors: Xue-Tao Zhang and Hao Zhu.

Co-corresponding authors: Bei-Yuan Zhang and Wen-Kui Yu.

Author contributions: Zhang BY and Yu WK designed the study and revised the manuscript, they contributed equally to this manuscript and are co-corresponding authors; Zhang XT and Zhu H collected the data and prepared the manuscript, they contributed equally to this manuscript and are co-first authors; Chen XC and Gao T assisted with data analysis and revised the manuscript; Chen M and Zhu ZH secured funding and revised the manuscript. All authors contributed to the study and approved the final manuscript.

Supported by Jiangsu Provincial Health Commission, No. BJ24037.

Institutional review board statement: This study received ethical approval from the Ethics Committee of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School (approval No. 2025-0786-01). The study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki.

Informed consent statement: As this was a retrospective study, the requirement for written informed consent was waived by the ethics committee. All patient data were anonymized to protect privacy.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request and subject to compliance with institutional data sharing policies.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Wen-Kui Yu, MD, PhD, Chief, Professor, Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. yudrnj2@163.com

Received: October 10, 2025
Revised: November 17, 2025
Accepted: December 29, 2025
Published online: February 21, 2026
Processing time: 130 Days and 3.5 Hours

Abstract

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.

Keywords: Acute pancreatitis; Severity; Organ failure; Mortality; Cohort study

Core Tip: The relationship between organ failure (OF) patterns and mortality in severe acute pancreatitis (AP) remains controversial. In this retrospective cohort of 151 patients with severe AP, we found that, after adjusting for initial multi-OF, the duration of OF, and infected pancreatic necrosis, the occurrence of new-onset OF - especially new-onset multi-OF - significantly increased both in-hospital and 90-day mortality rates. This novel perspective expands the theoretical framework linking OF patterns to adverse outcomes in AP and may prove pivotal for future pancreatitis grading systems and the design of related clinical trials.