Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Pancreatology. 2020 Dec;20(8):1582-1586. doi: 10.1016/j.pan.2020.09.013. Epub 2020 Sep 22.
/Objectives: The management of acute pancreatitis (AP) in China has undergone major changes since the launch of the updated guideline in 2013. This study aimed to evaluate the impact of this guideline on clinical practice and patient outcome.
Moderately severe and severe adult AP patients, who were admitted to Peking Union Medical College Hospital from January 1, 2001 to December 31, 2016, were retrospectively included in the study. All enrolled patients were divided into two groups based on the publication date of the updated guideline, as the pre-guideline (Pre) group and post-guideline (Post) group. In-hospital case-fatality rates were compared between two groups after adjusting baseline features, including gender, age, etiology and disease severity. In addition, the associations between specific therapeutic approaches recommended in the updated guideline and in-hospital case-fatality rates were explored.
A total of 475 patients were enrolled in this study, including 273 (57%) in the Pre group and 202 (43%) in the Post group. The adjusted in-hospital case-fatality rate significantly decreased in the Post group (14.3% vs. 5.9%, OR 0.39, 95%CI 0.19-0.82). In the post-hoc analysis, the use of enteral nutrition was a protective factor against in-hospital death (OR: 0.08, 95%CI: 0.03-0.18), while open surgery showed an opposite effect (OR: 3.81, 95%CI: 1.06-13.74). Prophylactic antibiotics was not significantly associated with in-hospital death (OR: 1.00, 95%CI: 0.39-2.60).
There was a prominent transition in the management of moderately severe and severe AP after the release of the guideline in China in 2013, which made the prognosis better.
/目的：自 2013 年更新指南发布以来，中国急性胰腺炎（AP）的管理发生了重大变化。本研究旨在评估该指南对临床实践和患者结局的影响。
回顾性纳入 2001 年 1 月 1 日至 2016 年 12 月 31 日期间入住北京协和医学院医院的中度和重度成人 AP 患者。所有纳入患者根据更新指南的发表日期分为两组，即指南前（Pre）组和指南后（Post）组。在调整性别、年龄、病因和疾病严重程度等基线特征后，比较两组患者的院内病死率。此外，还探讨了更新指南中推荐的特定治疗方法与院内病死率之间的关系。
本研究共纳入 475 例患者，其中 Pre 组 273 例（57%），Post 组 202 例（43%）。Post 组患者的院内病死率显著降低（14.3% vs. 5.9%，OR 0.39，95%CI 0.19-0.82）。事后分析显示，肠内营养的使用是降低院内死亡的保护因素（OR：0.08，95%CI：0.03-0.18），而开腹手术则有相反的效果（OR：3.81，95%CI：1.06-13.74）。预防性使用抗生素与院内死亡无显著相关性（OR：1.00，95%CI：0.39-2.60）。
2013 年中国指南发布后，中度和重度 AP 的管理发生了显著转变，使预后更好。
