Mihoc Tudorel, Pirvu Catalin, Dobrescu Amadeus, Brebu Dan, Macovei Anca Monica Oprescu, Pantea Stelian, Borza Claudia, Dumitrescu Patrick, Cara Monica Laura
Department X, Surgical Emergencies Clinic, "Victor Babeș" University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania.
Department X, 2nd Surgical Clinic, Researching Future "Chirurgie 2", "Victor Babeș" University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania.
Biomedicines. 2025 Mar 26;13(4):797. doi: 10.3390/biomedicines13040797.
: Severe acute pancreatitis carries a substantial risk of complications and death. Prompt identification of prognostic factors is crucial to optimize management and reduce mortality. This study aims to compare inflammatory scores, laboratory markers, and clinical outcomes between survivors and non-survivors with severe acute pancreatitis, drawing on data from 179 patients admitted between 2017 and 2024. : We conducted a retrospective cohort study of 179 patients diagnosed with severe acute pancreatitis. Of these, 55 patient records were extracted from an existing database, and an additional 124 were included from hospital archives (2017-2024). We divided participants into survivors ( = 121) and non-survivors ( = 58). Clinical data were obtained from medical records, including demographic information, comorbidities, laboratory markers (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)), and severity scores (Acute Physiology and Chronic Health Evaluation (APACHE), Computed Tomography Severity Index (CTSI), and Ranson). : Non-survivors had significantly higher ages (mean of 66.4 vs. 52.7 years, = 0.002), elevated inflammatory markers (median NLR of 14.2 vs. 10.3, = 0.031), and more frequent multiorgan failure (75.9% vs. 31.4%, < 0.001). The timing of intervention before 28 days was associated with higher mortality ( = 0.004). Chronic kidney disease and advanced cardiovascular comorbidities independently predicted worse survival ( = 0.009). The mortality rate in this cohort was 32.4%. Logistic regression identified age >60 years with an odds ratio (OR = 2.9), multiple organ failure (OR = 4.1), and high severity scores as primary contributors to mortality. : Advanced age, comorbidities, elevated inflammatory markers, and multiple organ failure significantly impact mortality in severe acute pancreatitis. Delaying major interventions when feasible, optimizing perioperative care, and early recognition of high-risk patients may improve outcomes. Further research should explore targeted management strategies for high-risk groups and refine the role of delayed or minimally invasive approaches in severe acute pancreatitis management.
重症急性胰腺炎具有较高的并发症风险和死亡风险。及时识别预后因素对于优化治疗和降低死亡率至关重要。本研究旨在比较重症急性胰腺炎幸存者和非幸存者的炎症评分、实验室指标及临床结局，研究数据来源于2017年至2024年间收治的179例患者。
我们对179例诊断为重症急性胰腺炎的患者进行了一项回顾性队列研究。其中，55份患者记录从现有数据库中提取，另外124份从医院档案（2017 - 2024年）中纳入。我们将参与者分为幸存者（n = 121）和非幸存者（n = 58）。临床数据从病历中获取，包括人口统计学信息、合并症、实验室指标（中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR））以及严重程度评分（急性生理与慢性健康状况评估（APACHE）、计算机断层扫描严重指数（CTSI）和兰森标准）。
非幸存者年龄显著更大（平均66.4岁对52.7岁，P = 0.002），炎症指标升高（NLR中位数14.2对10.3，P = 0.031），多器官功能衰竭更频繁（75.9%对31.4%，P < 0.001）。28天前进行干预与更高的死亡率相关（P = 0.004）。慢性肾脏病和晚期心血管合并症独立预测生存情况更差（P = 0.009）。该队列的死亡率为32.4%。逻辑回归确定年龄>60岁（比值比（OR）= 2.9）、多器官功能衰竭（OR = 4.1）和高严重程度评分是死亡的主要因素。
高龄、合并症、炎症指标升高和多器官功能衰竭对重症急性胰腺炎的死亡率有显著影响。在可行的情况下推迟重大干预、优化围手术期护理以及早期识别高危患者可能改善结局。进一步的研究应探索针对高危人群的靶向管理策略，并完善延迟或微创方法在重症急性胰腺炎管理中的作用。
