The Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
Dig Dis Sci. 2019 Feb;64(2):553-560. doi: 10.1007/s10620-018-5359-y. Epub 2018 Nov 22.
Pancreatic necrosis is a risk factor for poor prognosis of acute pancreatitis (AP). However, the associations between the findings on initial contrast-enhanced computed tomography (CT) of the pancreas and infected pancreatic necrosis (IPN) are unclear.
This was a retrospective cohort study. Patients with severe AP (SAP) from January 2014 to December 2016 at the First Affiliated Hospital of Nanchang University were enrolled and assigned to an IPN group and a non-IPN group. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and IPN development. A receiver operating characteristic (ROC) curve was generated for the qualified independent risk factor.
Forty-two patients with IPN were compared with 100 patients without IPN. Contrast-enhanced CT was performed 7 (range 3-10) days after AP onset. Multivariate stepwise logistic regression analyses showed that the number of acute peripancreatic fluid collections (APFCs) (OR 1.328, P = 0.006), presence of peripancreatic and pancreatic parenchymal necrosis (OR 4.001, P = 0.001), and gastrointestinal wall thickening (OR 3.353, P = 0.006) were independent risk factors for IPN secondary to SAP. The area under an ROC curve for the number of APFCs was 0.714, the sensitivity was 78.60%, and the specificity was 57.30% at a cutoff value of 4.5.
The number of APFCs, presence of peripancreatic and pancreatic parenchymal necrosis, and gastrointestinal wall thickening were independent risk factors associated with IPN. As initial contrast-enhanced CT (about 7 days from AP onset) plays an important role in predicting IPN, it is important for clinicians to consider initial imaging of the pancreas.
胰腺坏死是急性胰腺炎（AP）预后不良的一个危险因素。然而，初始增强 CT 胰腺扫描结果与感染性胰腺坏死（IPN）之间的关联尚不清楚。
这是一项回顾性队列研究。纳入了 2014 年 1 月至 2016 年 12 月南昌大学第一附属医院收治的重症急性胰腺炎（SAP）患者，并将其分为 IPN 组和非 IPN 组。对变量与 IPN 发展之间的关系进行单因素和多因素逻辑回归分析。为合格的独立危险因素生成受试者工作特征（ROC）曲线。
共比较了 42 例 IPN 患者和 100 例非 IPN 患者。增强 CT 是在 AP 发病后 7 天（范围 3-10 天）进行的。多因素逐步逻辑回归分析显示，急性胰周液体积聚（APFC）的数量（OR 1.328，P = 0.006）、胰周和胰腺实质坏死的存在（OR 4.001，P = 0.001）和胃肠壁增厚（OR 3.353，P = 0.006）是 SAP 继发 IPN 的独立危险因素。APFC 数量的 ROC 曲线下面积为 0.714，截断值为 4.5 时，灵敏度为 78.60%，特异性为 57.30%。
APFC 的数量、胰周和胰腺实质坏死的存在以及胃肠壁增厚是与 IPN 相关的独立危险因素。由于初始增强 CT（AP 发病后约 7 天）在预测 IPN 方面具有重要作用，因此临床医生考虑对胰腺进行初始影像学检查非常重要。
