Horlach A. COMPREHENSIVE TREATMENT OF ACUTE SEVERE PANCREATITIS: PROGNOSIS, PREVENTION AND CORRECTION OF COMPLICATIONS

Acute severe pancreatitis remains a serious medical and social problem due to its high mortality rate, significant morbidity and substantial burden on the healthcare system (Zhou et al., 2019; Hu et al., 2023; Jiang et al., 2023). Although severe forms account for a relatively small proportion of cases, they are the ones that determine the clinical course and outcomes of the disease due to the development of multiple organ failure and infectious complications (Liu et al., 2024; Deng et al., 2025). Mortality in such cases can exceed 30–40%. Epidemiological data indicate a rise in incidence and persistently high mortality rates . Furthermore, the disease often has a relapsing course with a potential transition to chronic forms, which exacerbates the medical and social burden. A key factor in prognosis is the development and duration of organ failure. It is systemic disturbances that determine the risk of death to a greater extent than localised changes. The course of the disease is phasic, with the development of early, delayed and late fatal complications: early complications are associated with persistent organ failure, whilst infection and nutritional depletion are key factors in later stages. Current severity assessment scales (BISAP, APACHE II, SOFA) are useful for initial stratification, but have limited prognostic accuracy as they do not account for the dynamics of clinical status and changes in organ dysfunction over time. The course of severe pancreatitis is a dynamic process in which the risk of fatal complications varies depending on time, the severity of systemic disturbances, and the timeliness of treatment. At the same time, existing models are predominantly static in nature and do not allow for the assessment of these changes or the possibilities for their targeted correction. The role of key mechanisms – abdominal perfusion disorders, infection, nutritional status and the spread of necrosis – and their interactions at different stages of the disease remains poorly understood. There is a lack of integrated approaches to their comprehensive assessment. In this context, a risk-oriented approach with the identification of control points and dynamic assessment of abnormalities is promising, as it allows not only for the prediction but also for the modification of the risk of complications through timely intervention. Thus, acute severe pancreatitis requires the refinement of approaches to dynamic forecasting, risk stratification taking into account time intervals, and the development of effective algorithms for the prevention and correction of fatal complications. Connection of work with scientific programs, plans, and topics. The dissertation work was carried out as part of the planned scientific and research work “Development and refinement of methods for the diagnosis, prognosis and surgical treatment of complications associated with diseases of the hepatopancreatoduodenal area” (No. 0123U100953, 2023-2025 yy.), carried out at the Department of General and Emergency Surgery of the Bogomolets National Medical University of the Ministry of Health of Ukraine. The dissertatition work is part of the aforementioned research topic and corresponds to its scientific focus. The aim of the study: to improve treatment outcomes for patients with acute severe pancreatitis by enhancing the prediction, prevention and management of fatal complications. Objectives of the study: 1. To study the leading causes of death among patients with severe pancreatitis and classify them according to survival time intervals. 2. To stratify patients with acute severe pancreatitis according to their risk of fatal complications, taking into account the cumulative and dynamic characteristics of early organ failure. 3. To identify predictors of mortality and systematise them into determinants of fatal complications of severe pancreatitis. 4. To develop a patient-oriented dynamic model for predicting the risk of early, delayed and late fatal complications. 5. To analyse the role of key determinants in shaping the risk of early, delayed and late fatal complications. 6. To develop a risk-oriented algorithm for the prevention and management of abdominal perfusion disorders in patients with acute severe pancreatitis. 7. To propose an algorithm for the prevention and management of the risk of progression of infectious complications in patients with acute severe pancreatitis, taking into account the levels of their escalation. 8. To refine the algorithm for the prevention of late fatal complications, taking into account the risk of nutritional disorders in patients with severe pancreatitis. 9. Optimise surgical methods for the prevention and management of post-pancreonecrotic complications in patients with acute severe pancreatitis. 10. Evaluate the effectiveness of the proposed treatment algorithm in patients with acute severe pancreatitis.