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Yagi S, Miwa H, Kobayashi Y, Mitsusada K. Infected Walled-Off Necrosis Following COVID-19-Associated Acute Pancreatitis. Cureus 2024; 16:e51889. [PMID: 38327952 PMCID: PMC10849867 DOI: 10.7759/cureus.51889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
A 54-year-old man was admitted for fever and dyspnea. He presented with severe COVID-19 pneumonia and elevated amylase and lipase levels. He received treatment for COVID-19 and possible acute pancreatitis (AP). Although pneumonia and amylase levels improved, a high-grade fever persisted. On day 39, abdominal CT revealed heterogenous liquid and non-liquid components with a well-defined wall around the pancreas, and he was diagnosed with infected walled-off necrosis (WON) after AP. It was concluded to be associated with COVID-19 because there were no identifiable causes, such as alcohol consumption, gallstones, or other viral infections. The necrotic collection and fever improved after endoscopic transgastric drainage and necrosectomy. SARS-CoV-2 is becoming recognized as a new etiological infectious factor for AP, and COVID-19-associated AP shows higher severity and mortality. Clinicians should evaluate COVID-19 patients for concomitant AP, and if it is present, they should carefully monitor the development of local complications, including WON.
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Affiliation(s)
- Shota Yagi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Hideki Miwa
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
| | - Yosuke Kobayashi
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
| | - Kenta Mitsusada
- Department of Emergency Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, JPN
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Li G, Li S, Cao L, Mao W, Zhou J, Ye B, Zhang J, Ding L, Zhu Y, Ke L, Liu Y, Tong Z, Li W. Nomogram development and validation for predicting minimally invasive step-up approach failure in infected necrotizing pancreatitis patients: a retrospective cohort study. Int J Surg 2023; 109:1677-1687. [PMID: 37144670 PMCID: PMC10389492 DOI: 10.1097/js9.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Previous studies have shown that minimally invasive treatment for infected necrotizing pancreatitis (INP) may be safer and more effective than open necrosectomy (ON), but ON is still irreplaceable in a portion of INP patients. Furthermore, there is a lack of tools to identify INP patients at risk of minimally invasive step-up approach failure (eventually received ON or died), which may enable appropriate treatment for them. Our study aims to identify risk factors that can predict minimally invasive step-up approach failure in INP patients and to develop a nomogram for early prediction. METHODS Multivariate logistic regression was performed to evaluate the association between minimally invasive step-up approach failure and factors regarding demographics, disease severity, laboratory index, and the location of extrapancreatic necrotic collections. A novel nomogram was developed, and its performance was validated both internally and externally by its discrimination, calibration, and clinical usefulness. RESULTS There were 267, 89, and 107 patients in the training, internal, and external validation cohorts, respectively. Multivariate logistic regression demonstrated that the computed tomography severity index (CTSI) greater than 8 points, Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 16 points or more, early spontaneous bleeding, fungi infection, granulocyte and platelet decrease within 30 days of acute pancreatitis onset, and extrapancreatic necrosis collection located in small bowel mesentery were independent risk factors for minimally invasive step-up approach failure. The area under the curve and coefficient of determination ( R2 ) of the nomogram constructed from the above factors were 0.920 and 0.644, respectively. The Hosmer-Lemeshow test showed that the model had good fitness ( P =0.206). In addition, the nomogram performed well in both the internal and external validation cohorts. CONCLUSIONS The nomogram had a good performance in predicting minimally invasive step-up approach failure, which may help clinicians distinguish INP patients at risk of minimally invasive step-up approach failure early.
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Affiliation(s)
- Gang Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
| | - Shuai Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
| | - Longxiang Cao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
| | - Wenjian Mao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
| | - Jing Zhou
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
| | - Bo Ye
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
| | - Jingzhu Zhang
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
| | - Ling Ding
- Department of Medical Statistics, Jinling Hospital, Medical School of Nanjing University
| | - Yin Zhu
- Department of Medical Statistics, Jinling Hospital, Medical School of Nanjing University
| | - Lu Ke
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu
| | - Yuxiu Liu
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Zhihui Tong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
| | - Weiqin Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing Medical University
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu
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Garret C, Douillard M, David A, Péré M, Quenehervé L, Legros L, Archambeaud I, Douane F, Lerhun M, Regenet N, Gournay J, Coron E, Frampas E, Reignier J. Infected pancreatic necrosis complicating severe acute pancreatitis in critically ill patients: predicting catheter drainage failure and need for necrosectomy. Ann Intensive Care 2022; 12:71. [PMID: 35916981 PMCID: PMC9346045 DOI: 10.1186/s13613-022-01039-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/25/2022] [Indexed: 11/27/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01039-z.
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Affiliation(s)
- Charlotte Garret
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France.
| | - Marion Douillard
- Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Arthur David
- Radiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Morgane Péré
- Plateforme de Méthodologie et Biostatistique, Direction de la Recherche, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Lucille Quenehervé
- Service d'Hépatogastroentérologie, Centre Hospitalier Universitaire de Brest, 29200, Brest, France
| | - Ludivine Legros
- Service d'Hépatogastroentérologie, Centre Hospitalier Universitaire de Rennes, 35203, Rennes, France
| | - Isabelle Archambeaud
- Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Frédéric Douane
- Radiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marc Lerhun
- Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Nicolas Regenet
- Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Jerome Gournay
- Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Emmanuel Coron
- Institut des Maladies de L'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Eric Frampas
- Radiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
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