Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Pancreatology. 2013 Jul-Aug;13(4):355-9. doi: 10.1016/j.pan.2013.05.003. Epub 2013 May 21.
Infected (peri)pancreatic necrosis (IPN) in acute pancreatitis (AP) is associated with organ failure (OF) and high mortality. There are no established early markers of primary IPN. This study aimed to assess the association of simple parameters with primary IPN in AP.
We retrospectively studied 281 patients with AP admitted to Mayo Clinic hospitals and identified those with microbiologically confirmed infections in (peri)pancreatic necrosis and collections. We defined primary IPN as infection of (peri)pancreatic necrotic tissue that developed before interventions. We recorded admission hematocrit, BMI, BUN, serum creatinine, SIRS score and development of persistent organ failure within 48 h of admission; and performed serial SIRS and BUN calculations for at least 48 h. We used univariate and multivariable analysis to assess associations and expressed results as odds ratio (OR)[95% CI].
27 (9.6%) patients developed IPN, of which 21 (77.7%) had primary IPN. 38.1% had Gram positive, 9.5% Gram negative and 52.3% mixed bacterial infections. Five (23.8%) of the patients with IPN had fungal infection. On univariate analysis, SIRS ≥ 2 at admission, rise in BUN by 5 mg/dL within 48 h of admission, persistence of SIRS for 48 h and development of persistent OF within 48 h of disease had significant association with development of primary IPN with OR (95% CI) of 4.12 (1.53-11.15), 10.25 (3.95-26.61), 1.19 (1.69-10.39) and 7.62 (2.58-21.25) [2-tailed p = 0.004, <0.0001, 0.002 and <0.0001] respectively. On multivariable analysis, only rise in BUN by 5 mg/dL within 48 h of admission was associated with primary IPN (p = 0.007).
Rising BUN within 48 h of admission can be used to predict development of primary IPN in AP.
急性胰腺炎（AP）合并感染性（胰周）坏死（IPN）与器官衰竭（OF）和高死亡率相关。目前尚无明确的原发性 IPN 的早期标志物。本研究旨在评估 AP 中简单参数与原发性 IPN 的相关性。
我们回顾性研究了在梅奥诊所医院就诊的 281 例 AP 患者，并确定了微生物学证实的胰腺和胰周坏死及脓肿感染患者。我们将原发性 IPN 定义为在干预措施之前发生的胰腺和胰周坏死组织感染。我们记录入院时的血细胞比容、BMI、BUN、血清肌酐、SIRS 评分和入院后 48 小时内持续器官衰竭的发生情况；并至少进行 48 小时的连续 SIRS 和 BUN 计算。我们使用单变量和多变量分析来评估相关性，并以比值比（OR）[95%CI]表示结果。
27 例（9.6%）患者发生 IPN，其中 21 例（77.7%）为原发性 IPN。38.1%为革兰阳性菌感染，9.5%为革兰阴性菌感染，52.3%为混合细菌感染。5 例（23.8%）患者有真菌感染。单变量分析显示，入院时 SIRS≥2 分、入院后 48 小时内 BUN 升高 5mg/dL、48 小时内持续 SIRS 和入院后 48 小时内持续 OF 与原发性 IPN 的发生有显著相关性，比值比（OR）（95%CI）分别为 4.12（1.53-11.15）、10.25（3.95-26.61）、1.19（1.69-10.39）和 7.62（2.58-21.25）[双侧 p=0.004、<0.0001、0.002 和 <0.0001]。多变量分析显示，仅入院后 48 小时内 BUN 升高 5mg/dL 与原发性 IPN 相关（p=0.007）。
入院后 48 小时内 BUN 升高可用于预测 AP 中原发性 IPN 的发生。
