Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Dig Dis Sci. 2015 Feb;60(2):537-42. doi: 10.1007/s10620-014-3081-y. Epub 2014 Mar 13.
Hypotension and intestinal mucosal ischemia lead to bacterial translocation from the gut lumen into systemic circulation.
The purpose of this study was to determine the strength of association between different types of organ failure (OF): hypotension (cardiovascular system failure), renal failure, respiratory failure, CNS failure and coagulopathy in the first week of acute pancreatitis (AP) and the subsequent development of infected pancreatic necrosis (IN).
Consecutive patients with AP were evaluated for OF and its severity in the first week of hospital admission. Modified multiple organ failure score (MOFS) was used to identify and grade severity of OF. MOFS of ≥2, lasting for more than 48 h was defined as OF. Occurrence of IN (isolation of bacteria in necrosectomy specimen or image guided fine needle aspiration of pancreatic necrosis) was compared between groups with and without OF.
Of the 81 patients, mean age was 40.1 ± 14.4 years and 55 were males; 60 (74 %) patients had OF and 13 (16 %) patients had IN. Occurrence of IN was not significantly different between patients with OF (18.3 %) and without OF (14.3 %), p = 0.48. However IN occurred in 10 % of patients without and 33.7 % patients with hypotension, p = 0.01. The rest of the organ systems analyzed did not show any significant difference in occurrence of infected necrosis. On multivariate analysis independent predictors of occurrence of IN were hypotension (odds ratio, OR 2.5, p < 0.001) and APACHE II score at 24 h of hospital admission (OR 4.77, p < 0.001).
Hypotension in the first week of AP and APACHE II score predict development of IN.
低血压和肠道黏膜缺血会导致肠道腔中的细菌易位进入体循环。
本研究旨在确定不同类型器官衰竭（OF）在急性胰腺炎（AP）的第一周内与随后发生感染性胰腺坏死（IN）之间的关联强度：低血压（心血管系统衰竭）、肾衰竭、呼吸衰竭、中枢神经系统衰竭和凝血功能障碍。
连续评估入院后第一周内 AP 患者的 OF 及其严重程度。使用改良多器官衰竭评分（MOFS）来识别和分级 OF 的严重程度。MOFS ≥2 且持续超过 48 小时被定义为 OF。比较有无 OF 组之间 IN 的发生情况（坏死切除术标本中分离出细菌或胰腺坏死的影像引导细针抽吸）。
在 81 例患者中，平均年龄为 40.1 ± 14.4 岁，男性 55 例；60 例（74%）患者存在 OF，13 例（16%）患者发生 IN。有 OF 的患者（18.3%）与无 OF 的患者（14.3%）相比，IN 的发生率无显著差异，p = 0.48。然而，无低血压的患者中 IN 的发生率为 10%，而低血压的患者中 IN 的发生率为 33.7%，p = 0.01。分析的其余器官系统在发生感染性坏死方面没有显示出任何显著差异。多变量分析表明，IN 的发生的独立预测因子是低血压（优势比，OR 2.5，p < 0.001）和入院后 24 小时的 APACHE II 评分（OR 4.77，p < 0.001）。
AP 第一周的低血压和 APACHE II 评分可预测 IN 的发生。
