Acute necrotizing pancreatitis (ANP) is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with acute pancreatitis (AP) based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course. The aim of the study was to determine patient- and initial treatment-related risk factors for the development of acute necrotizing pancreatitis. For the purpose of this study a case-control design was chosen, including adult patients treated for AP in the surgical Intensive Care Unit (sICU) of Clinical Center of Kragujevac, from January 2006 to January 2011. The cases (n=63) were patients who developed ANP, while the controls (n=63) were patients with AP without the presence of pancreatic necrosis. The controls were randomly selected from a study sample after matching with the cases by age and sex. Significant association with the development of ANP was found for the presence of comorbidity (adjusted OR 6.614 95%CI 1.185-36.963), and the use of somatostatin (adjusted OR 7.460, 95%CI 1.162-47.833) and furosemide (adjusted OR 2710.57, 95%CI 1.996-56.035) started immediately upon admission to the sICU. This study suggests that comorbidities, particularly the presence of serious cardio-vascular disease, can increase the risk for development of acute necrotizing pancreatitis. The probability for the development of ANP could be reduced by the avoidance of the initial use of loop diuretics and somatostatin.

СКРАЋЕНИЦЕAGD -Алaнил-глутамин дипептид АRR -Смањење апсолутног ризика CVVH -Континуирана вено-венозна хе-мофилтрација CRAI -Континуирана регионална арте-ријска инфузија EP -Ендоскопска папилотомија ERCP -Ендоскопска ретроградна холан-гиопанкреатографија E-selectin (CD 62E) -Ћелијски адхезиони молекул "ISNS" -Индивидуална постепена хран-љива потпора LMWH -Нискомолекуларни хепарин NG -Назогастрично NJ -Назојејунално NNT -Број болесника које требa лечити да би се спречио један негативни исход PAF -Фактор активације тромбоцита PTGD -Перкутана трансхепатична дре-нажа жучне кесице RCTs -Рандомизирана контролисана кли-ничка испитивања SAP -Тежак акутни панкреатитис TEN -Тотална ентерална исхрана TNF-alfa, IL-1 beta, IL-6, IL-8 -Цитокини, хуморални посредници запаљења TPN -Тотална парентерална исхрана САЖЕТАКАкутни панкреатитис је акутни запаљењ-ски процес у панкреасу са променљивим учешћем других регионалних ткива или уда-љених органских система. Тешка форма бoлести се јавља у 10-20% случајева, проду-женог је тока и обично због високе учесталости локалних и системских компли-кација, захтева болничко лечење. Узевши у обзир и значајну учесталост смртних исхода упркос дијагностичким и терапијским до-стигнућима, ова болест представља озбиљан здравствено-економски проблем данашњице.Циљ овог рада је анализом резултата ран-домизованих контролисаних истраживања утврдити разлике у ефикасности између ста-ндардних метода лечења тешког акутног пан-креатитиса и нових терапијских модалитета, у смислу смањења ризика од смртног исхода. Прегледом медицинске литературе и претра-живањем "МЕДЛАЈН" базе података ориги-налних научних радова и систематских пре-гледних чланака, комбинацијом кључних речи: акутни панкреатитис, лечење, мортали-тет, пронађено је укупно 914 радова, објав-љених у последњих 13 година; 64 рада одно-сила су се на рандомизирана контролисана клиничка испитивања, од чега је укупно 14 радова задовољило критеријуме за селекцију и екстракцију података. Од укупно 16 ода-браних радова, на конзервативно лечење односило се 11, што укључује и неке од нових терапијских модалитета, док су ефекти нових

The aim of the paper was to determine the factors related to the initial therapy that may contribute to death from severe necrotizing acute pancreatitis and to analyze their clinical importance as well as possible additive effects.A retrospective case-control study included all adult patients treated for severe necrotizing acute pancreatitis in the Clinical Center of Kragujevac, Serbia, during the five-year period (2006-2010.). The cases (n = 41) were patients who died, while the controls (n = 69) were participants who survived. In order to estimate the relationship between potential risk factors and observed outcome, crude and adjusted odds ratios (OR) with 95 % confidence intervals (CI) were calculated in logistic regression models.Significant association with observed outcome was shown for the use of gelatin and/or hydroxyethyl starch (adjusted OR 12.555; 95 % CI 1.150-137.005), use of albumin (adjusted OR 27.973; 95 % CI 1.741-449.373), use of octreotide (adjusted OR 16.069; 95 % CI 1.072-240.821) and avoiding of enteral feeding (adjusted OR 3.933; 95 % CI 1.118-13.829), while the use of nonsteroidal anti-inflammatory drugs had protective role (adjusted OR 0.057; 95 % CI 0.004-0.805).The risk of death in patients with predicted severe necrotizing acute pancreatitis could be reduced with avoidance of treatment with colloid solutions, albumin and octreotide, as well as with an early introduction of oral/enteral nutrition and use of nonsteroidal anti-inflammatory drugs. O r i g i n a l a r t i c l e I NT ROD U CT I ONSevere necrotizing acute pancreatitis is a multisystem disorder, characterized by pancreatic and/or peripancreatic tissue necrosis and widespread inflammatory response leading to single or multiple organ dysfunction which does not resolve within the first 48 hours (the so-called persistent organ failure according to revised Atlanta criteria 2012) (1). It occurs in about 15-20 % of all cases of acute pancreatitis (AP) and is considered the most serious disease course due to high complications and death rates despite recent diagnostic and therapeutic advancements; the mortality may be particularly high if necrotic areas become infected, exceeding 50 % when infection and persistent organ failure develop during the first week of the illness (1-4).In the light of these facts, taking also into account variable and unpredictable course of AP, current recommendations emphasize appropriate early management based on careful initial risk assessment in all patients presenting with AP on admission to hospital (1, 4). Dealing with this issue, previous studies have identified numerous factors that are only associated with or may contribute to the development of severe disease and increased mortality rate in patients with AP. Many of them are well-documented, such as older age, obesity, idiopathic AP, important comorbidities, as well as certain clinical, laboratory and radiologic parameters of disease severity on initial evaluation (signs of systemic inflammatory response syndrome, hypotension, altered mental sta...