左心室辅助装置治疗与急性胰腺炎：更高的发生率和更差的临床结局。

Left Ventricular Assist Device Therapy and Acute Pancreatitis: Higher Incidence and Worse Clinical Outcomes.

机构信息

From the Divisions of Gastroenterology and Hepatology.

Transplant Medicine, Mayo Clinic, Jacksonville, FL.

出版信息

Pancreas. 2020 Sep;49(8):1069-1074. doi: 10.1097/MPA.0000000000001624.

DOI:10.1097/MPA.0000000000001624

PMID:32769855

Abstract

OBJECTIVE

The aim of the study was to compare incidence and outcomes of acute pancreatitis among advanced heart failure therapies.

METHODS

Two retrospective cohorts are as follows: A, patients with heart failure presenting to our hospitals and B, the US National Inpatient Sample. Three groups were compared: left ventricular assist device (LVAD) recipients, transplant recipients, and controls who did not qualify for advanced therapies. Primary outcomes were pancreatitis incidence and mortality. Secondary outcomes included kidney failure, multiorgan failure, shock, and health care utilization.

RESULTS

Cohort A included 1344 heart failure patients, and cohort B included 677,905 patients with acute pancreatitis. In cohort A, annual pancreatitis incidence was 6.7 cases per 1000 LVAD recipients, 4.1 per 1000 LVAD bridge-to-transplant, 2.3 per 1000 transplant recipients, and 3.2 per 1000 heart failure controls (P = 0.03). Combined, the incidence was 5.6 per 1000 LVAD users and 2.7 in 1000 non-LVAD users (relative risk, 2.1; P = 0.009). In cohort B, increased mortality was seen in LVAD users, but not in transplant recipients. Left ventricular assist device patients had higher odds of kidney failure, multiorgan failure, shock, and intensive care.

CONCLUSIONS

Patients with LVAD have double risk of pancreatitis, worse clinical outcomes, and increased healthcare utilization. Studies elucidating the mechanisms behind pancreatic injury in advanced heart failure are suggested.

摘要

目的

本研究旨在比较心力衰竭治疗中急性胰腺炎的发生率和结局。

方法

我们回顾了两个队列：A 队列为我院就诊的心力衰竭患者，B 队列为美国国家住院患者样本。将三组进行比较：左心室辅助装置（LVAD）受者、移植受者和不符合高级治疗标准的对照组。主要结局为胰腺炎的发生率和死亡率。次要结局包括肾衰竭、多器官衰竭、休克和医疗保健利用。

结果

A 队列包括 1344 例心力衰竭患者，B 队列包括 677905 例急性胰腺炎患者。在 A 队列中，LVAD 受者每年胰腺炎发生率为 6.7 例/1000 例，LVAD 桥接移植为 4.1 例/1000 例，移植受者为 2.3 例/1000 例，心力衰竭对照组为 3.2 例/1000 例（P=0.03）。综合来看，LVAD 使用者的发生率为 5.6 例/1000 例，非 LVAD 使用者为 2.7 例/1000 例（相对风险，2.1；P=0.009）。在 B 队列中，LVAD 使用者的死亡率增加，但移植受者没有增加。LVAD 患者发生肾衰竭、多器官衰竭、休克和重症监护的几率更高。