Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Medicine (Baltimore). 2021 Nov 19;100(46):e27901. doi: 10.1097/MD.0000000000027901.
While some acute pancreatitis (AP) patents with fever do not exhibit a corresponding increase in heart rate, the clinical significance of this phenomenon has not been studied. We investigated the clinical relevance of relative bradycardia (RB) in febrile AP.A retrospective electronic chart review was conducted on consecutive patients admitted for AP at a tertiary referral center in Japan from January 1, 2010, to May 31, 2018. Presence of RB was determined at the first instance of fever, based on formulas used in previous studies.Fever at or during admission was observed in 115 patients, of which 33% had RB. Fever was observed at presentation in 48% and within 48 hours in 94% of cases. Etiologies were alcoholic in 48% and gallstones in 17% of cases. RB patients were older (median age: 62 vs 51 years, P = .028) but had shorter median postfever lengths of stay (8 vs 12 days, P = .003), lower median Ranson scores (1 vs 2, P < .001), and were less likely to develop delirium (11% vs 38%, P = .002). Nineteen of 21 severe AP cases based on the Ranson score were nonbradycardia (P = .011). RB was also associated with lower white blood cell count, C-reactive protein, and lactate levels. On computed tomography, necrosis (P = .028) and moderate or severe pancreatitis (P = .041) were less frequently observed in patients with RB. There was a significant inverse correlation between RB and the Ranson score (-.305, P = .001). While RB was an independent predictors of postfever length of stay (LOS) in multiple regression analysis when the Ranson score was excluded (P = .010), it ceased to be significant when the Ranson score was included (P = .141).AP patients with RB at fever onset had milder disease and shorter LOS compared to those with higher heart rates at fever onset. RB may be useful as a simple, early predictor of shorter LOS before the Ranson score can be calculated.
虽然一些发热的急性胰腺炎 (AP) 患者的心率没有相应增加，但这种现象的临床意义尚未得到研究。我们研究了发热性 AP 中相对心动过缓 (RB) 的临床相关性。
我们对 2010 年 1 月 1 日至 2018 年 5 月 31 日期间在日本一家三级转诊中心因 AP 入院的连续患者进行了回顾性电子病历审查。根据之前研究中使用的公式，在发热首次出现时确定 RB 的存在。
在 115 名发热患者中，有 33%存在 RB。发热发生在入院时的占 33%，在入院 48 小时内的占 94%。病因分别为酒精性 48%和胆石症 17%。RB 患者年龄较大（中位数年龄：62 岁比 51 岁，P = 0.028），但发热后住院时间中位数较短（8 天比 12 天，P = 0.003），中位 Ranson 评分较低（1 分比 2 分，P < 0.001），发生谵妄的可能性较低（11%比 38%，P = 0.002）。根据 Ranson 评分，21 例严重 AP 病例中 19 例为非心动过缓（P = 0.011）。RB 也与白细胞计数、C 反应蛋白和乳酸水平较低有关。在 CT 上，RB 患者的坏死（P = 0.028）和中重度胰腺炎（P = 0.041）的发生率较低。RB 与 Ranson 评分呈显著负相关（-0.305，P = 0.001）。在排除 Ranson 评分后，多变量回归分析显示 RB 是发热后住院时间（LOS）的独立预测因素（P = 0.010），但当包括 Ranson 评分时，RB 不再具有统计学意义（P = 0.141）。
发热时出现 RB 的 AP 患者与发热时心率较高的患者相比，疾病较轻，住院时间较短。在可以计算 Ranson 评分之前，RB 可能是 LOS 较短的简单、早期预测指标。
