Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University,Haikou, Hainan, China.
Department of Emergency Surgery,The First Affiliated Hospital of Hainan Medical University,Haikou, Hainan, China.
Clin Res Hepatol Gastroenterol. 2022 May;46(5):101901. doi: 10.1016/j.clinre.2022.101901. Epub 2022 Mar 15.
Acute pancreatitis (AP) is a self-limiting disease. However, 20-30% of patients will develop into severe AP (SAP), and infectious pancreatic necrosis in the late course of SAP is the leading cause of death for such patients. This review aims to provide a comprehensive and systematic report of the currently published risk factors for complicated infectious pancreatic necrosis in patients with severe acute pancreatitis by meta-analysis of published retrospective case-control studies.
Five electronic database systems were selected to search for articles on risk factors of infectious pancreatic necrosis in patients with severe acute pancreatitis. According to the heterogeneity among studies, the standardized mean difference (SMD), odds ratio and 95% confidence interval (95%CI) were calculated by applying a random-effects model or fixed-effects model, respectively.
As of 2nd Jun, 2021, a total of 1408 articles were searched, but only 21 articles were finally included in this meta-analysis. The results found that patients with severe acute pancreatitis complicated by infected pancreatic necrosis had higher APACHE II scores and higher levels of lipase (LPS), C-reactive protein (CRP) and procalcitonin (PCT) compared to patients with severe acute pancreatitis alone. The differences were statistically significant (APACHE II: SMD = 0.86, 95%CI: 0.55, 1.18; LPS: SMD = 1.52, 95%CI: 1.13, 1.92; CRP: SMD = 1.42, 95%CI: 1.05, 1.79; PCT: SMD = 1.82, 95%CI: 1.36, 2.28).
Compared with patients with severe acute pancreatitis alone, high levels of LPS, CRP, PCT and high APACHE II score were risk factors for infectious pancreatic necrosis in patients with severe acute pancreatitis.
急性胰腺炎（AP）是一种自限性疾病。然而，20-30%的患者会发展为重症急性胰腺炎（SAP），SAP 病程后期的感染性胰腺坏死是此类患者死亡的主要原因。本综述旨在通过对已发表的回顾性病例对照研究进行荟萃分析，提供一份全面、系统的关于重症急性胰腺炎患者并发感染性胰腺坏死的现有危险因素的报告。
选择五个电子数据库系统，检索关于重症急性胰腺炎患者感染性胰腺坏死危险因素的文章。根据研究间的异质性，分别采用随机效应模型或固定效应模型计算标准化均数差（SMD）、比值比和 95%置信区间（95%CI）。
截至 2021 年 6 月 2 日，共检索到 1408 篇文章，但最终只有 21 篇文章纳入本荟萃分析。结果发现，与单纯重症急性胰腺炎患者相比，并发感染性胰腺坏死的重症急性胰腺炎患者的 APACHE II 评分更高，且脂肪酶（LPS）、C 反应蛋白（CRP）和降钙素原（PCT）水平更高，差异具有统计学意义（APACHE II：SMD=0.86，95%CI：0.55，1.18；LPS：SMD=1.52，95%CI：1.13，1.92；CRP：SMD=1.42，95%CI：1.05，1.79；PCT：SMD=1.82，95%CI：1.36，2.28）。
与单纯重症急性胰腺炎患者相比，高水平的 LPS、CRP、PCT 和高 APACHE II 评分是重症急性胰腺炎患者发生感染性胰腺坏死的危险因素。
