Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Hepato-Biliary-Pancreatic Surgery, Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, China.
Department of Hepato-Biliary-Pancreatic Surgery, Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, China.
Ann Palliat Med. 2021 Nov;10(11):11745-11755. doi: 10.21037/apm-21-2933.
Biliary and hypertriglyceridemic acute pancreatitis (BAP and HTGAP) are two of the leading etiologies in China. Infected pancreatic necrosis (IPN) is a particular and noticeable condition in the late stage of these diseases; however, the influential correlated factors on IPN and how to predict IPN are unclear.
In this retrospective study, 1,116 patients whose diagnosis was BAP or HTGAP met the inclusion criteria among 1,746 enrolled cases. Clinical characteristics were carefully recorded for further investigation of the factors influencing IPN. During a 6-month follow-up, we analyzed bacterial spectra and postoperative indicators related to minimally invasive necrosectomy.
Gallstones and hypertriglyceridemia were the most prevalent causes (52.6% vs. 11.3%). The participants with HTGAP were younger (40 vs. 52 years, P<0.001), had a higher rate of severe acute pancreatitis (SAP) (51.8% vs. 32.0%, P<0.001), and had a higher prevalence of multiple organ dysfunction syndrome (MODS) (26.4% vs. 19.0%, P=0.020) than BAP patients. More IPN cases were noted in the BAP group than in the HTGAP group [20.2% vs. 13.7%; odds ratio (OR): 1.598, 95% confidence interval (CI): 1.027 to 2.451; P=0.034]. Etiologies, C-reactive protein (CRP) levels, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and MODS were the factors influencing IPN. The bacterial spectra and the rates of major postoperative complications were not significantly different.
Patients with BAP more frequently developed IPN. Etiology was independently related to the occurrence of IPN. The APACHE II score, MODS, etiology, and CRP contributed to predicting IPN occurrence. Management of IPN substantially improved the prognosis.
胆源性和高脂血症性急性胰腺炎（BAP 和 HTGAP）是中国两种主要的病因。感染性胰腺坏死（IPN）是这些疾病晚期的一种特殊且显著的情况；然而，影响 IPN 的相关因素以及如何预测 IPN 尚不清楚。
在这项回顾性研究中，在纳入的 1746 例患者中，有 1116 例诊断为 BAP 或 HTGAP 的患者符合纳入标准。仔细记录临床特征，以进一步研究影响 IPN 的因素。在 6 个月的随访期间，我们分析了微创坏死清除术后的细菌谱和相关术后指标。
胆石症和高三酰甘油血症是最常见的病因（52.6% vs. 11.3%）。HTGAP 组患者更年轻（40 岁 vs. 52 岁，P<0.001），SAP 发生率更高（51.8% vs. 32.0%，P<0.001），多器官功能障碍综合征（MODS）发生率更高（26.4% vs. 19.0%，P=0.020）。BAP 组的 IPN 病例多于 HTGAP 组[20.2% vs. 13.7%；比值比（OR）：1.598，95%置信区间（CI）：1.027 至 2.451；P=0.034]。病因、C 反应蛋白（CRP）水平、急性生理学和慢性健康评估 II（APACHE II）评分和 MODS 是影响 IPN 的因素。细菌谱和主要术后并发症发生率无显著差异。
BAP 患者更常发生 IPN。病因与 IPN 的发生独立相关。APACHE II 评分、MODS、病因和 CRP 有助于预测 IPN 的发生。IPN 的治疗显著改善了预后。
