Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China.
Hepatobiliary Pancreat Dis Int. 2024 Feb;23(1):77-82. doi: 10.1016/j.hbpd.2023.04.003. Epub 2023 Apr 11.
Early systemic anticoagulation (SAC) is a common practice in acute necrotizing pancreatitis (ANP), and its impact on in-hospital clinical outcomes had been assessed. However, whether it affects long-term outcomes is unknown. This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.
During January 2013 and December 2018, ANP patients admitted within 7 days from the onset of abdominal pain were screened. The primary outcome was 90-day readmission after discharge. Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.
A total of 241 ANP patients were enrolled, of whom 143 received early SAC during their hospitalization and 98 did not. Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis (SVT) [risk ratio (RR) = 0.40, 95% CI: 0.26-0.60, P < 0.01] and lower 90-day readmission with an RR of 0.61 (95% CI: 0.41-0.91, P = 0.02) than those who did not. For the quality of life, patients who received early SAC had a significantly higher score in the subscale of vitality (P = 0.03) while the other subscales were all comparable between the two groups. Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57 (95% CI: 0.34-0.96, P = 0.04). Mediation analysis showed that SVT mediated 37.0% of the early SAC-90-day readmission causality.
The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients, and reduced SVT incidence might be the primary contributor.
急性坏死性胰腺炎（ANP）患者常接受早期全身抗凝（SAC）治疗，且其对住院期间临床结局的影响已得到评估。然而，SAC 是否会影响长期结局尚不明确。本研究旨在评估 SAC 对 ANP 患者出院后 90 天再入院和其他长期结局的影响。
2013 年 1 月至 2018 年 12 月，筛选腹痛发作 7 天内入院的 ANP 患者。主要结局为出院后 90 天再入院。采用 Cox 比例风险回归模型和中介分析来明确早期 SAC 与 90 天再入院之间的关系。
共纳入 241 例 ANP 患者，其中 143 例在住院期间接受了早期 SAC，98 例未接受。接受早期 SAC 的患者肠系膜静脉血栓形成（SVT）发生率较低（风险比 [RR] = 0.40，95%可信区间：0.26-0.60，P < 0.01），90 天再入院率也较低，RR 为 0.61（95%可信区间：0.41-0.91，P = 0.02）。在生活质量方面，接受早期 SAC 的患者活力亚量表评分显著较高（P = 0.03），而两组其他亚量表评分均无显著差异。多变量 Cox 回归模型显示，在校正潜在混杂因素后，早期 SAC 是 90 天再入院的独立保护因素，风险比为 0.57（95%可信区间：0.34-0.96，P = 0.04）。中介分析表明，SVT 介导了早期 SAC-90 天再入院因果关系的 37.0%。
早期 SAC 的应用可能降低 ANP 患者幸存者 90 天再入院的风险，降低 SVT 发生率可能是主要贡献因素。
