Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China.
Department of Emergency Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, China.
BMC Infect Dis. 2021 Mar 17;21(1):267. doi: 10.1186/s12879-021-05964-5.
To assess the prevalence, risk factors, clinical characteristics, and outcomes of acute pancreatitis (AP) in patients with hemorrhagic fever with renal syndrome (HFRS).
All patients diagnosed with HFRS admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to July 2020 were enrolled. Patients with and without AP were compared by two risk stratification models: (1) a multivariate regression analysis using propensity score to adjust for confounding and (2) a propensity-matched nested case-control study.
A total of 346 patients were enrolled in the cohort study, 29 of whom (8.4%) were diagnosed as AP. There was no significant difference between patients with and without AP with regards to common risk factors and presenting signs/symptoms other than gastrointestinal symptoms (p < 0.01). The patients with AP had a significantly higher 90-day mortality rate (24.1% vs. 3.5%, OR 8.9, 95% CI 1.3 to 103.4, p = 0.045), and significantly shorter duration of therapy free-days to 28 day such as RRT and mechanical ventilation free days (p < 0.05, respectively).
Our study indicated that AP was independently associated with higher mortality in HFRS patients. While considering the difficulty of early recognition of AP among HFRS patients with similar signs and/or symptoms, further laboratory and imaging studies might help identify these patients at risk of poor clinical prognosis.
评估肾综合征出血热（HFRS）患者中急性胰腺炎（AP）的患病率、危险因素、临床特征和结局。
纳入 2013 年 1 月至 2020 年 7 月西安交通大学第一附属医院收治的所有诊断为 HFRS 的患者。通过两种风险分层模型（1：使用倾向评分调整混杂因素的多变量回归分析；2：倾向匹配嵌套病例对照研究）比较有无 AP 的患者。
共纳入 346 例队列研究患者，其中 29 例（8.4%）诊断为 AP。除胃肠道症状外，AP 患者与无 AP 患者在常见危险因素和表现症状/体征方面无显著差异（p<0.01）。AP 患者 90 天死亡率显著更高（24.1% vs. 3.5%，OR 8.9，95%CI 1.3 至 103.4，p=0.045），无肾脏替代治疗（RRT）和机械通气天数至 28 天自由天数（RRT 自由天数和机械通气自由天数）的治疗时间显著更短（p<0.05，分别）。
本研究表明，AP 与 HFRS 患者死亡率升高独立相关。考虑到 HFRS 患者具有相似的体征和/或症状时早期识别 AP 的难度，进一步的实验室和影像学研究可能有助于识别这些预后不良风险较高的患者。
