胰腺外感染在急性胰腺炎严重程度及局部并发症预测中的作用。
The role of extra-pancreatic infections in the prediction of severity and local complications in acute pancreatitis.
作者信息
Pando Elizabeth, Alberti Piero, Hidalgo Jimmy, Vidal Laura, Dopazo Cristina, Caralt Mireia, Blanco Laia, Gómez-Gavara Concepción, Bilbao Itxarone, Balsells Joaquim, Charco Ramon
机构信息
Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
出版信息
Pancreatology. 2018 Jul;18(5):486-493. doi: 10.1016/j.pan.2018.05.481. Epub 2018 May 19.
BACKGROUND
The aim of our study was to determine the risk factors for extrapancreatic infection (EPI) occurrence and its predictive power for assessing severity and local complications in acute pancreatitis including infected pancreatic necrosis (IPN).
METHODS
Clinical data of 176 AP patients prospectively enrolled were analysed. EPI analysed were bacteraemia, lung infection, urinary tract infection and catheter line infection. Risk factors analysed were: Leukocyte count, C-reactive protein, liver function test, serum calcium, serum glucose, Blood urea nitrogen, mean arterial pressure at admission, total parenteral nutrition (TPN), enteral nutrition, hypotension, respiratory, cardiovascular and renal failure at admission, persistent systemic inflammatory response (SIRS) and intrapancreatic necrosis. Severity outcomes assessed were defined according to the Atlanta Criteria definition for acute pancreatitis. The predictive accuracy of EPI for morbidity and mortality was measured using area-under-the-curve (AUC) receiver-operating characteristics.
RESULTS
Forty-four cases of EPI were found (25%). TPN (OR:9.2 CI95%: 3.3-25.7), APACHE-II>8 (OR:6.2 CI95%:2.48-15.54) and persistent SIRS (OR:2.9 CI95%: 1.1-7.8), were risk factors related with EPI. Bacteraemia, when compared with others EPI, showed the best accuracy in predicting significantly persistent organ failure (AUC:0.76, IC95%:0.64-0.88), ICU admission (AUC:0.80 IC95%:0.65-0.94), and death (AUC:0.73 CI95%:0.54-0.91); and for local complications including IPN (AUC:0.72 CI95%:0.53-0.92) as well. Besides, it was also needed for an interventional procedure against necrosis (AUC:0.74 IC95%: 0.57-0.91). When bacteraemia and IPN occurs, bacteraemia preceded infected necrosis in all cases. On multivariate analysis, risk factor for IPN were lung infection (OR:6.25 CI95%1.1-35.7 p = 0.039) and TPN (OR:22.0CI95%:2.4-205.8, p = 0.007), and for mortality were persistent SIRS at first week (OR: 22.9 CI95%: 2.6-203.7, p = 0.005) and Lung infection (OR: 9.7 CI95%: 1.7-53.8).
CONCLUSION
In our study, EPI, played a role in predicting the severity and local complications in acute pancreatitis.
背景
我们研究的目的是确定胰腺外感染（EPI）发生的危险因素及其对评估急性胰腺炎（包括感染性胰腺坏死，IPN）严重程度和局部并发症的预测能力。
方法
对前瞻性纳入的176例急性胰腺炎患者的临床资料进行分析。分析的胰腺外感染包括菌血症、肺部感染、尿路感染和导管相关感染。分析的危险因素包括：白细胞计数、C反应蛋白、肝功能检查、血钙、血糖、血尿素氮、入院时平均动脉压、全胃肠外营养（TPN）、肠内营养、低血压、入院时呼吸、心血管和肾衰竭、持续性全身炎症反应（SIRS）和胰腺内坏死。根据亚特兰大急性胰腺炎诊断标准评估严重程度结局。使用曲线下面积（AUC）接受者操作特征曲线测量胰腺外感染对发病率和死亡率的预测准确性。
结果
发现44例胰腺外感染（25%）。TPN（比值比：9.2，95%置信区间：3.3 - 25.7）、急性生理与慢性健康状况评分系统II（APACHE-II）>8（比值比：6.2，95%置信区间：2.48 - 15.54）和持续性SIRS（比值比：2.9，95%置信区间：1.1 - 7.8）是与胰腺外感染相关的危险因素。与其他胰腺外感染相比，菌血症在预测持续性器官功能衰竭（AUC：0.76，95%置信区间：0.64 - 0.88）、入住重症监护病房（AUC：0.80，95%置信区间：0.65 - 0.94）和死亡（AUC：0.73，95%置信区间：0.54 - 0.91）方面显示出最佳准确性；对于包括IPN在内的局部并发症（AUC：0.72，95%置信区间：0.53 - 0.92）也是如此。此外，针对坏死的介入治疗也有必要（AUC：0.74，95%置信区间：0.57 - 0.91）。当菌血症和IPN同时发生时，所有病例中菌血症先于感染性坏死出现。多因素分析显示，IPN的危险因素为肺部感染（比值比：6.25，95%置信区间：1.1 - 35.7，p = 0.039）和TPN（比值比：22.0，95%置信区间：2.4 - 205.8，p = 0.007），死亡的危险因素为第一周持续性SIRS（比值比：22.9，95%置信区间：2.6 - 203.7，p = 0.005）和肺部感染（比值比：9.7，95%置信区间：1.7 -
53.8）。
结论
在我们的研究中，胰腺外感染在预测急性胰腺炎的严重程度和局部并发症方面发挥了作用。
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