Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between...

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Published in:Updates in surgery 2023-04, Vol.75 (3), p.493-522
Main Authors: Podda, Mauro, Pellino, Gianluca, Di Saverio, Salomone, Coccolini, Federico, Pacella, Daniela, Cioffi, Stefano Piero Bernardo, Virdis, Francesco, Balla, Andrea, Ielpo, Benedetto, Pata, Francesco, Poillucci, Gaetano, Ortenzi, Monica, Damaskos, Dimitrios, De Simone, Belinda, Sartelli, Massimo, Leppaniemi, Ari, Jayant, Kumar, Catena, Fausto, Giuliani, Antonio, Di Martino, Marcello, Pisanu, Adolfo
Format: Article
Language:English
Subjects:
Adult
Drainage - methods
Endoscopy - methods
Enteral Nutrition
Humans
Intraabdominal Infections - etiology
Medicine
Medicine & Public Health
NCT
NCT04747990
Original
Original Article
Pancreatitis, Acute Necrotizing - surgery
Risk Factors
Surgery
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Summary:The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension ( p  = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA ( p  = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure ( p  = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure ( p  = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis ( p  = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome ( p  = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding ( p  = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality ( p  
ISSN:2038-131X
2038-3312
DOI:10.1007/s13304-023-01488-6