Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis

BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was condu...

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Bibliographic Details
Published in:Hepatobiliary & pancreatic diseases international 2016-08, Vol.15 (4), p.428-433
Main Authors: Ji, Liang, Lv, Jia-Chen, Song, Zeng-Fu, Jiang, Mai-Tao, Li, Le, Sun, Bei
Format: Article
Language:English
Subjects:
Adult
Area Under Curve
Bacterial Infections - blood
Bacterial Infections - diagnosis
Bacterial Infections - microbiology
Bacterial Infections - mortality
Biomarkers - blood
D-dimer
D-二聚体
Disease Progression
Endocrinology & Metabolism
enteral nutrition
Female
Fibrin Fibrinogen Degradation Products - metabolism
Gastroenterology and Hepatology
Health Status
Health Status Indicators
Hospital Mortality
Humans
infected pancreatic necrosis
intra-abdominal pressure
Logistic Models
Logistic回归分析
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Pancreatitis, Acute Necrotizing - blood
Pancreatitis, Acute Necrotizing - diagnosis
Pancreatitis, Acute Necrotizing - microbiology
Pancreatitis, Acute Necrotizing - mortality
Predictive Value of Tests
Pressure
Prognosis
Reproducibility of Results
Retrospective Studies
risk factor
Risk Factors
ROC Curve
severe acute pancreatitis
Severity of Illness Index
Time Factors
临床资料
危险因素
坏死
感染性
早期识别
重症急性胰腺炎
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Summary:BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.
ISSN:1499-3872
DOI:10.1016/S1499-3872(15)60043-1