Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan.
J Gastroenterol. 2018 Sep;53(9):1098-1106. doi: 10.1007/s00535-018-1452-4. Epub 2018 Mar 21.
Although continuous regional arterial infusion (CRAI) of protease inhibitors and broad antibiotics has been suggested as one of the therapeutic option for patients with acute necrotic pancreatitis (ANP), the effectiveness has not been well-corroborated in clinical studies.
We conducted a retrospective cohort study using a Japanese national administrative database. Severe acute pancreatitis patients with a poorly enhanced pancreas region (i.e., definitive or clinically suspected ANP) were identified and dichotomized according to whether CRAI was performed. We compared the outcomes of in-hospital mortality, surgical interventions, hospital-free days, and healthcare costs between groups adjusted by the well-validated case-mix adjustment model using a multivariate mixed-effect regression analysis and a propensity score matching analysis.
Of 243,312 acute pancreatitis patients, 702 eligible patients were identified, of these 339 patients underwent CRAI. The case-mix adjustment model established had good predictability for in-hospital mortality with an area under the receiver operating characteristics curve of 0.87. CRAI was significantly associated with reduced in-hospital mortality [14.5% in the CRAI group vs. 18.2% in the non-CRAI group, adjusted odds ratio (95% confidence interval; CI) = 0.60 (0.36-0.97)]. Significant associations were not observed for the frequency of surgical interventions and mean hospital-free days; however, significantly higher healthcare costs were observed in the CRAI group. Results of the propensity score matching analysis did not alter these results.
Analysis of a nationwide large-scale database suggested that CRAI was significantly associated with reduced in-hospital mortality for patients with ANP. Further randomized controlled trials are warranted.
虽然持续区域性动脉输注（CRAI）蛋白酶抑制剂和广谱抗生素已被建议作为急性坏死性胰腺炎（ANP）患者的治疗选择之一，但在临床研究中其疗效尚未得到充分证实。
我们使用日本国家行政数据库进行了回顾性队列研究。确定了胰腺区域增强不良（即明确或临床疑似 ANP）的重症急性胰腺炎患者，并根据是否进行 CRAI 将其分为两组。我们通过多变量混合效应回归分析和倾向评分匹配分析，使用经过良好验证的病例组合调整模型，对两组患者的住院死亡率、手术干预、住院天数和医疗保健费用进行了比较。
在 243312 例急性胰腺炎患者中，确定了 702 例符合条件的患者，其中 339 例患者接受了 CRAI。建立的病例组合调整模型对住院死亡率具有良好的预测性，接受者操作特征曲线下面积为 0.87。CRAI 与降低住院死亡率显著相关[CRAI 组为 14.5%，非 CRAI 组为 18.2%，调整后的优势比（95%置信区间；CI）=0.60（0.36-0.97）]。手术干预频率和平均住院天数无显著相关性；然而，CRAI 组的医疗保健费用显著较高。倾向评分匹配分析的结果并未改变这些结果。
对大规模国家数据库的分析表明，CRAI 与 ANP 患者的住院死亡率降低显著相关。需要进一步的随机对照试验。
