Dambrauskas Zilvinas, Gulbinas Antanas, Pundzius Juozas, Barauskas Giedrius
Laboratory for Research of the GI Tract, Institute for Biomedical Research, Kaunas University of Medicine, Kaunas, Lithuania.
Scand J Gastroenterol. 2007 Oct;42(10):1256-64. doi: 10.1080/00365520701391613.
Fine-needle aspiration (FNA) is the procedure of choice for accurate diagnosis of infected necrosis. However, invasive procedures increase the risk of secondary pancreatic infection and the timing of FNA is still a matter for debate. Our objective was to assess the value of routine clinical tests to determine the minimal risk for infected necrosis, thereby optimizing timing and selection of patients for image-guided FNA.
This prospective, non-randomized study comprised 90 patients with acute necrotizing pancreatitis. The data of 52 patients were used for discriminant function analysis to determine the differences between patients with infected necrosis and those with sterile necrosis. Cut-off points for variables were established using receiver operating characteristic (ROC) curve analysis and logistic regression was performed to determine the risk of infected necrosis. The clinical relevance of the defined diagnostic system was prospectively tested in a further 38 consecutive patients with acute necrotizing pancreatitis (ANP).
Discriminant function analysis showed that C-reactive protein (CRP) and white blood cell (WBC) values were significant discriminators between patients with sterile necrosis and those with infected necrosis. Cut-off values of 81 mg/l for CRP and 13 x 10(9)/l for WBC were established. The predicted risk for infected necrosis is approx. 1.4% if both tests are below the defined cut-off values. Consequently, we found FNA unnecessary in this subset of patients, unless otherwise indicated, as this invasive procedure per se carries a certain risk of bacterial contamination.
Routine clinical tests are helpful in diagnosing the development of infected necrosis. Based on the application of classification functions, the timing and selection of patients for image-guided FNA can be optimized.
细针穿刺抽吸术（FNA）是准确诊断感染性坏死的首选方法。然而，侵入性操作会增加继发性胰腺感染的风险，且FNA的时机仍存在争议。我们的目的是评估常规临床检查对于确定感染性坏死最低风险的价值，从而优化影像引导下FNA的患者选择时机。
这项前瞻性、非随机研究纳入了90例急性坏死性胰腺炎患者。使用52例患者的数据进行判别函数分析，以确定感染性坏死患者与无菌性坏死患者之间的差异。通过受试者操作特征（ROC）曲线分析确定变量的截断点，并进行逻辑回归以确定感染性坏死的风险。在另外38例连续的急性坏死性胰腺炎（ANP）患者中前瞻性地测试所定义诊断系统的临床相关性。
判别函数分析表明，C反应蛋白（CRP）和白细胞（WBC）值是无菌性坏死患者与感染性坏死患者之间的显著判别指标。确定CRP的截断值为81mg/l，WBC的截断值为13×10⁹/l。如果两项检查均低于确定的截断值，则感染性坏死的预测风险约为1.4%。因此，我们发现对于这部分患者，除非另有指示，否则无需进行FNA，因为这种侵入性操作本身存在一定的细菌污染风险。
常规临床检查有助于诊断感染性坏死的发生。基于分类函数的应用，可以优化影像引导下FNA的患者选择时机。
