Fu Bao, Fan Zhonghong, Gao Fei, Su DDe, Hu Jie, Geng Zhengguang, Fu Xiaoyun
Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Diagnosis and Treatment Center for Severe Acute Pancreatitis of Guizhou Province, Guiyang 563003, Guizhou, China.
Department of Critical Care Medicine, Dejiang People's Hospital, Tongren 565200, Guizhou, China. Corresponding author: Fu Xiaoyun, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Jan;34(1):70-74. doi: 10.3760/cma.j.cn121430-20210128-00159.
To explore the risk factors of abdominal hemorrhage (AH) in patients with severe acute pancreatitis (SAP) and its impact on outcome.
The clinical data of 231 SAP patients admitted to Diagnosis and Treatment Center for SAP of Guizhou Province from January 1, 2015 to December 31, 2019 were retrospectively analyzed. These patients were divided into AH group and non-AH group. The general information, etiology, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, organ failure, complications, interventions, bleeding time, bleeding site and outcome were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the risk factors of AH in SAP patients and whether the time and location of AH were risk factors affecting the outcome.
A total of 231 patients were enrolled in the analysis, including 198 patients without AH and 33 with AH (14.3%). There was no significant difference in gender, age or etiology between the two groups. The scores of APACHE II and SOFA in AH group were significantly higher than those in non-AH group [APACHE II score: 18 (12, 24) vs. 13 (9, 19), SOFA score: 9 (5, 15) vs. 5 (4, 11), both P < 0.01]. The incidences of acute kidney injury (AKI), gastrointestinal dysfunction, coagulation disorders, necrotic infection, pseudocyst and gastrointestinal fistula in AH group were significantly higher than those in non-AH group (66.7% vs. 47.0%, 36.4% vs. 7.1%, 18.2% vs. 6.6%, 66.7% vs. 9.1%, 66.7% vs. 34.3%, 9.1% vs. 1.5%, all P < 0.05). The proportions of requiring mechanical ventilation (MV) and surgical intervention in AH group were significantly higher than those in non-AH group (69.7% vs. 43.4, 48.5% vs. 14.6%, both P < 0.01). The length of intensive care unit (ICU) stay and hospital stay in AH group were significantly longer than those in non-AH group [length of ICU stay (days): 13 (8, 19) vs. 7 (3, 16), length of hospital stay: 24 (13, 40) vs. 17 (12, 24), both P < 0.01], and the hospital mortality was significantly higher (60.6% vs. 9.6%, P < 0.01). Multivariate Logistic regression analysis showed that APACHE II score [odds ratio (OR) = 1.157, 95% confidence interval (95%CI) was 1.030-1.299, P = 0.014], infectious necrosis (OR = 12.211, 95%CI was 4.063-36.697, P < 0.01), pseudocyst (OR = 3.568, 95%CI was 1.238-10.283, P = 0.019) and requiring MV (OR = 0.089, 95%CI was 1.354-6.625, P = 0.007) were the risk factors of AH in SAP patients. In 33 AH patients, there was no significant difference in hospital mortality between early hemorrhage (occurred within 2 weeks of onset) and late hemorrhage (occurred 2 weeks after onset) groups [66.7% (8/12) vs. 57.1% (12/21), P > 0.05]. All 4 patients in the unspecified bleeding site group died during hospitalization; half or more patients died in the pseudocyst/abscess bleeding (14 cases), mesenteric/intestinal bleeding (13 cases) and gastric variceal bleeding (2 cases) groups (7 cases, 8 cases and 1 case respectively), and there were significant differences among the groups (P < 0.05). Multivariate Logistic regression analysis showed that neither bleeding time (OR = 0.989, 95%CI was 0.951-1.028, P = 0.574) nor bleeding site (OR = 2.009, 95%CI was 0.822-4.907, P = 0.126) was the risk factor of death in patients with SAP combined with AH.
Both early and late bleeding significantly increased the length of hospital stay and mortality of SAP patients. APACHE II score, infectious necrosis and pseudocyst were the risk factors of AH in SAP patients. Neither bleeding time nor bleeding site was the risk factors of death in patients with SAP combined with AH. However, it still needed to be confirmed by a large sample clinical study.
探讨重症急性胰腺炎（SAP）患者腹腔出血（AH）的危险因素及其对预后的影响。
回顾性分析2015年1月1日至2019年12月31日贵州省SAP诊疗中心收治的231例SAP患者的临床资料。将这些患者分为AH组和非AH组。比较两组患者的一般资料、病因、急性生理与慢性健康状况评分系统II（APACHE II）评分、序贯器官衰竭评估（SOFA）评分、器官衰竭、并发症、干预措施、出血时间、出血部位及预后。采用二元多因素Logistic回归分析探讨SAP患者AH的危险因素以及AH的时间和部位是否为影响预后的危险因素。
共纳入231例患者进行分析，其中无AH患者198例，AH患者33例（14.3%）。两组患者的性别、年龄及病因无显著差异。AH组的APACHE II和SOFA评分显著高于非AH组[APACHE II评分：18（12，24）对13（9，19），SOFA评分：9（5，15）对5（4，11），均P<0.01]。AH组急性肾损伤（AKI）、胃肠功能障碍、凝血功能障碍、坏死感染、假性囊肿及胃肠瘘的发生率显著高于非AH组（66.7%对47.0%，36.4%对7.1%，18.2%对6.6%，66.7%对9.1%，66.7%对34.3%，9.1%对1.5%，均P<0.05）。AH组需要机械通气（MV）和手术干预的比例显著高于非AH组（69.7%对43.4%，48.5%对14.6%，均P<0.01）。AH组重症监护病房（ICU）住院时间和住院时间显著长于非AH组[ICU住院时间（天）：13（8，19）对7（3，16），住院时间：24（13，40）对17（12，24），均P<0.01]，且医院死亡率显著更高（60.6%对9.6%，P<0.01）。多因素Logistic回归分析显示，APACHE II评分[比值比（OR）=1.157，95%置信区间（95%CI）为1.030 - 1.299，P = 0.014]、感染性坏死（OR = 12.211，95%CI为4.063 - 36.697，P<0.01）、假性囊肿（OR = 3.568，95%CI为1.238 - 10.283，P = 0.019）和需要MV（OR = 0.089，95%CI为1. _ 354 - 6.625，P = 0.007）是SAP患者AH的危险因素。在33例AH患者中，早期出血（发病2周内发生）和晚期出血（发病2周后发生）组之间的医院死亡率无显著差异[66.7%（8/12）对57.1%（12/21），P>0.05]。未明确出血部位组的4例患者均在住院期间死亡；假性囊肿/脓肿出血（14例）、肠系膜/肠道出血（13例）和胃静脉曲张出血（2例）组中半数以上患者死亡（分别为7例、8例和1例），组间差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，出血时间（OR = 0.989，95%CI为0.951 - 1.028，P = 0.574）和出血部位（OR = 2.009，95%CI为0.822 - 4.907，P = 0.126）均不是SAP合并AH患者死亡的危险因素。
早期和晚期出血均显著增加了SAP患者的住院时间和死亡率。APACHE II评分、感染性坏死和假性囊肿是SAP患者AH的危险因素。出血时间和出血部位均不是SAP合并AH患者死亡的危险因素。然而，仍需大样本临床研究证实。
