感染性胰腺坏死并发危重症患者的严重急性胰腺炎：预测导管引流失败及坏死组织清除术的必要性
Infected pancreatic necrosis complicating severe acute pancreatitis in critically ill patients: predicting catheter drainage failure and need for necrosectomy.
作者信息
Garret Charlotte, Douillard Marion, David Arthur, Péré Morgane, Quenehervé Lucille, Legros Ludivine, Archambeaud Isabelle, Douane Frédéric, Lerhun Marc, Regenet Nicolas, Gournay Jerome, Coron Emmanuel, Frampas Eric, Reignier Jean
机构信息
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France.
Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France.
出版信息
Ann Intensive Care. 2022 Aug 2;12(1):71. doi: 10.1186/s13613-022-01039-z.
BACKGROUND
Recent guidelines advocate a step-up approach for managing suspected infected pancreatic necrosis (IPN) during acute pancreatitis. Nearly half the patients require secondary necrosectomy after catheter drainage. Our primary objective was to assess the external validity of a previously reported nomogram for catheter drainage, based on four predictors of failure. Our secondary objectives were to identify other potential predictors of catheter-drainage failure. We retrospectively studied consecutive patients admitted to the intensive care units (ICUs) of three university hospitals in France between 2012 and 2016, for severe acute pancreatitis with suspected IPN requiring catheter drainage. We assessed drainage success and failure rates in 72 patients, with success defined as survival without subsequent necrosectomy and failure as death and/or subsequent necrosectomy required by inadequate improvement. We plotted the receiver operating characteristics (ROC) curve for the nomogram and computed the area under the curve (AUROC).
RESULTS
Catheter drainage alone was successful in 32 (44.4%) patients. The nomogram predicted catheter-drainage failure with an AUROC of 0.71. By multivariate analysis, catheter-drainage failure was independently associated with a higher body mass index [odds ratio (OR), 1.12; 95% confidence interval (95% CI), 1.00-1.24; P = 0.048], heterogeneous collection (OR, 16.7; 95% CI, 1.83-152.46; P = 0.01), and respiratory failure onset within 24 h before catheter drainage (OR, 18.34; 95% CI, 2.18-154.3; P = 0.007).
CONCLUSION
Over half the patients required necrosectomy after failed catheter drainage. Newly identified predictors of catheter-drainage failure were heterogeneous collection and respiratory failure. Adding these predictors to the nomogram might help to identify patients at high risk of catheter-drainage failure.
CLINICALTRIALS
gov number: NCT03234166.
背景
近期指南提倡采用逐步升级的方法来处理急性胰腺炎期间疑似感染性胰腺坏死（IPN）。近半数患者在导管引流后需要进行二次坏死组织清除术。我们的主要目的是基于四个失败预测因素，评估先前报道的导管引流列线图的外部有效性。我们的次要目的是确定导管引流失败的其他潜在预测因素。我们回顾性研究了2012年至2016年间法国三家大学医院重症监护病房（ICU）收治的连续患者，这些患者患有疑似IPN的重症急性胰腺炎且需要进行导管引流。我们评估了72例患者的引流成功率和失败率，成功定义为存活且无需后续坏死组织清除术，失败定义为死亡和/或因改善不充分而需要进行后续坏死组织清除术。我们绘制了列线图的受试者工作特征（ROC）曲线并计算了曲线下面积（AUROC）。
结果
仅导管引流成功的患者有32例（44.4%）。列线图预测导管引流失败的AUROC为0.71。通过多变量分析，导管引流失败与较高的体重指数独立相关[比值比（OR），1.12；95%置信区间（95%CI），1.00 - 1.24；P = 0.048]、积液不均质（OR，16.7；95%CI，1.83 - 152.46；P = 0.01）以及在导管引流前24小时内出现呼吸衰竭（OR，18.34；95%CI，2.18 - 154.3；P = 0.007）。
结论
超过半数患者在导管引流失败后需要进行坏死组织清除术。新确定的导管引流失败预测因素是积液不均质和呼吸衰竭。将这些预测因素添加到列线图中可能有助于识别导管引流失败高风险患者。
临床试验
美国国立医学图书馆临床试验注册中心编号：NCT03234166。
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