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Ning C, Ouyang H, Shen D, Sun Z, Liu B, Hong X, Lin C, Li J, Chen L, Li X, Huang G. Prediction of survival in patients with infected pancreatic necrosis: a prospective cohort study. Int J Surg 2024; 110:777-787. [PMID: 37851523 PMCID: PMC10871654 DOI: 10.1097/js9.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Infected pancreatic necrosis (IPN) is a severe complication of acute pancreatitis, with mortality rates ranging from 15 to 35%. However, limited studies exist to predict the survival of IPN patients and nomogram has never been built. This study aimed to identify predictors of mortality, estimate conditional survival (CS), and develop a CS nomogram and logistic regression nomogram for real-time prediction of survival in IPN patients. METHODS A prospective cohort study was performed in 335 IPN patients consecutively enrolled at a large Chinese tertiary hospital from January 2011 to December 2022. The random survival forest method was first employed to identify the most significant predictors and capture clinically relevant nonlinear threshold effects. Instantaneous death risk and CS was first utilized to reveal the dynamic changes in the survival of IPN patients. A Cox model-based nomogram incorporating CS and a logistic regression-based nomogram were first developed and internally validated with a bootstrap method. RESULTS The random survival forest model identified seven foremost predictors of mortality, including the number of organ failures, duration of organ failure, age, time from onset to first intervention, hemorrhage, bloodstream infection, and severity classification. Duration of organ failure and time from onset to first intervention showed distinct thresholds and nonlinear relationships with mortality. Instantaneous death risk reduced progressively within the first 30 days, and CS analysis indicated gradual improvement in real-time survival since diagnosis, with 90-day survival rates gradually increasing from 0.778 to 0.838, 0.881, 0.974, and 0.992 after surviving 15, 30, 45, 60, and 75 days, respectively. After further variables selection using step regression, five predictors (age, number of organ failures, hemorrhage, time from onset to first intervention, and bloodstream infection) were utilized to construct both the CS nomogram and logistic regression nomogram, both of which demonstrated excellent performance with 1000 bootstrap. CONCLUSION Number of organ failures, duration of organ failure, age, time from onset to first intervention, hemorrhage, bloodstream infection, and severity classification were the most crucial predictors of mortality of IPN patients. The CS nomogram and logistic regression nomogram constructed by these predictors could help clinicians to predict real-time survival and optimize clinical decisions.
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Affiliation(s)
- Caihong Ning
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Hui Ouyang
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
| | - Dingcheng Shen
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Zefang Sun
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Baiqi Liu
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xiaoyue Hong
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Chiayen Lin
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Jiarong Li
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Lu Chen
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xinying Li
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
| | - Gengwen Huang
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
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Hu WM, Hua TR, Zhang YL, Chen GR, Song K, Pendharkar S, Wu D, Windsor JA. Prognostic significance of organ failure and infected pancreatic necrosis in acute pancreatitis: An updated systematic review and meta-analysis. J Dig Dis 2023; 24:648-659. [PMID: 38037512 DOI: 10.1111/1751-2980.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/15/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate recent evidence from published studies to determine the relative importance of IPN and OF as determinants of mortality in patients with AP (PROSPERO: CRD42020176989). METHODS Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance. RESULTS Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032). CONCLUSION Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.
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Affiliation(s)
- Wen Mo Hu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Rui Hua
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - Guo Rong Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Song
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sayali Pendharkar
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Khizar H, Zhicheng H, Chenyu L, Yanhua W, Jianfeng Y. Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis. Ann Med 2023; 55:2213898. [PMID: 37243522 DOI: 10.1080/07853890.2023.2213898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND/AIMS Pancreatic fluid collections (PFC) are debris or fluid of the pancreas that needs to be drained out. This may result from surgery or necrotizing pancreatitis. This meta-analysis compared the outcomes of PFC through endoscopic and percutaneous interventions. METHODS A medical database was searched up to June 2022, comparing the outcomes of endoscopic drainage (ED) and percutaneous drainage (PD) for the PFC. Eligible studies reporting clinical and technical success and adverse events were selected. RESULTS Seventeen studies with 1170 patients were included for meta-analysis, of which 543 patients underwent ED and 627 underwent PD. The odd ratio (OR) of technical success was 0.81 (95% confidence interval (CI) 0.31, 2.1) and clinical success was in the favor of the ED group at OR 2.23 (95% CI 1.45, 3.41). Adverse events OR 0.62 (95% CI 0.27, 1.39) and stent migration OR 0.61 (95% CI 0.10, 3.88) were the same in both groups, but hospital stay pooled mean difference of 15.02 days (95% CI 9.86, 20.18), mortality OR 0.24 (95% CI 0.09, 0.67), and re-interventions OR 0.25 (95% CI 0.16, 0.40) favored ED. CONCLUSIONS ED is safe and efficient for PFC with higher clinical success, lower mortality rate, hospital stay, and re-interventions compared with PD.
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Affiliation(s)
- Hayat Khizar
- Department of Gastroenterology, International Education College of Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of medicine, Hangzhou, China
| | - Huang Zhicheng
- Department of Gastroenterology, The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Le Chenyu
- Department of Gastroenterology, The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wu Yanhua
- Department of Gastroenterology, The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Jianfeng
- Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of medicine, Hangzhou, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
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Chesdachai S, Yetmar ZA, Lahr BD, Vege SS, Vergidis P. Clinical characteristics and outcomes of pancreatic fungal infection in patients with necrotizing pancreatitis. Med Mycol 2023:myad068. [PMID: 37433581 DOI: 10.1093/mmy/myad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Pancreatic fungal infection (PFI) in patients with necrotizing pancreatitis can lead to significant morbidity and mortality. The incidence of PFI has increased during the past decade. Our study aimed to provide contemporary observations on the clinical characteristics and outcomes of PFI in comparison to pancreatic bacterial infection and necrotizing pancreatitis without infection. We conducted a retrospective study of patients with necrotizing pancreatitis (acute necrotic collection or walled-off necrosis), who underwent pancreatic intervention (necrosectomy and/or drainage) and had tissue/fluid culture between 2005-2021. We excluded patients with pancreatic procedures prior to hospitalization. Multivariable logistic and Cox regression models were fitted for in-hospital and 1-year survival outcomes. 225 patients with necrotizing pancreatitis were included. Pancreatic fluid and/or tissue was obtained from endoscopic necrosectomy and/or drainage (76.0%), CT-guided percutaneous aspiration (20.9%) or surgical necrosectomy (3.1%). Nearly half of the patients had PFI with or without concomitant bacterial infection (48.0%), while the remaining patients had either bacterial infection alone (31.1%) or no infection (20.9%). In multivariable analysis to assess the risk of PFI or bacterial infection alone, only previous pancreatitis was associated with an increased odds of PFI vs. no infection (OR 4.07, 95% CI 1.13-14.69, p = .032). Multivariable regression analyses revealed no significant differences in in-hospital outcomes or one-year survival between the 3 groups. PFI occurred in nearly half of necrotizing pancreatitis. Contrary to many of the previous reports, there was no significant difference in important clinical outcomes between the PFI group and each of the other two groups.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachary A Yetmar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paschalis Vergidis
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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5
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Sun N, Chen Y, Zhang J, Cao J, Huang H, Wang J, Guo W, Li X. Identification and characterization of pancreatic infections in severe and critical acute pancreatitis patients using 16S rRNA gene next generation sequencing. Front Microbiol 2023; 14:1185216. [PMID: 37389346 PMCID: PMC10303115 DOI: 10.3389/fmicb.2023.1185216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Objectives This study aimed to identify the bacterial composition in the pancreatic fluid of severe and critical acute pancreatitis (SAP and CAP) patients. Methods A total of 78 pancreatic fluid samples were collected from 56 SAP and CAP patients and analyze using aerobic culture and 16S rRNA gene next-generation sequencing. The clinical data of the patients were obtained from the electronic medical records. Results Among the total 78 samples, 16S rRNA gene NGS identified a total of 660 bacterial taxa, belonging to 216 species in 123 genera. The dominant aerobic bacteria included Klebsiella pneumoniae, Acinetobacter baumannii, and Enterococcus faecium, while the dominant anaerobic bacteria included Bacteroides, Dialister invisus, and Olsenella uli. As compared to aerobic culturing, 95.96% (95/99) of the aerobic cultured bacteria were detected using the 16S rRNA gene NGS. Conclusion The pancreatic infections in SAP and CAP patients might originate not only from the gut but also from the oral cavity and airways as well as related environments. Dynamic analysis of bacterial profile and abundance showed that some bacteria with low abundance might become the main pathogenic bacteria. There were no significant differences in the bacterial diversity between SAP and CAP.
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Affiliation(s)
- Ning Sun
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yong Chen
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jiaxun Zhang
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jin Cao
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hongjuan Huang
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jie Wang
- Clinical Medicine Research Center, The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, China
| | - Wentao Guo
- Department of Microbiology and Immunology, College of Basic Medicine, Guangdong Medical University, Dongguan, China
| | - Xiaojun Li
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Hong W, Pan J, Goyal H, Zippi M. Editorial: Acute pancreatitis infection: Epidemiology, prevention, clinical characteristics, treatment, and prediction. Front Cell Infect Microbiol 2023; 13:1175195. [PMID: 37026058 PMCID: PMC10070966 DOI: 10.3389/fcimb.2023.1175195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- *Correspondence: Wandong Hong,
| | - Jingye Pan
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hemant Goyal
- Department of Surgery, University of Texas Health Sciences Center, Houston, TX, United States
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
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Obeid JA, Brosutti OD, García Calcaterra EM, Cian MS, García MF. [Infected pancreatic necrosis: Treatment with antibiotics alone. Would this be the first step of the step-up approach?]. Medicina (B Aires) 2023; 83:394-401. [PMID: 37379536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION In 1994, Claudio Bassi reported a case of medical treatment for infected pancreatic necrosis (IPN); then since 1996 numerous articles of case series were published with treatment only with antibiotics with good outcomes. OBJECTIVES To present our experience in the management of patients with IPN with antibiotics (without drainage). METHODS We retrospectively reviewed cases with a diagnosis of IPN from January 2018 to October 2020, focusing on those cases that were treated conservatively (hydro-electrolyte, nutritional support and antibiotics). The diagnosis was made by observing gas in the retroperitoneum by CT or by clinical deterioration of the patient with pancreatic necrosis without another focus. Fine needle aspiration was not performed. RESULTS We identified 25 patients with a diagnosis of IPN; eleven were treated conservatively. According to Atlanta, modified in 2012, 3 were classified severely and the rest moderately severe. All received antibiotics for at least 3 weeks. None required parenteral nutrition. The mean hospital stay was 38 days. Three patients were readmitted. 8 underwent cholecystectomy after having resolved the condition; the rest were already cholecystectomized. There were no deaths in this series. CONCLUSIONS IPN can be treated conservatively without drainage with good results in selected cases.
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Affiliation(s)
- Jorge A Obeid
- Servicio de Cirugía General, Hospital J. B. Iturraspe, Santa Fe, Argentina
| | - Oscar D Brosutti
- Servicio de Cirugía General, Hospital J. B. Iturraspe, Santa Fe, Argentina
| | | | - María S Cian
- Servicio de Cirugía General, Hospital J. B. Iturraspe, Santa Fe, Argentina
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Remizov SI, Andreev AV, Durleshter VM, Gabriel SA, Zasyadko OV. [A modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis]. Khirurgiia (Mosk) 2023:47-55. [PMID: 38010017 DOI: 10.17116/hirurgia202311147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To develop a modified method for percutaneous drainage of acute necrotic collections in patients with infected pancreatic necrosis. MATERIALS AND METHODS Minimally invasive surgical technologies were used in 74 patients with infected acute necrotic collections at the Krasnodar Regional Clinical Hospital No. 2 between 2017 and 2019. Of these, 59 (79.7%) people underwent percutaneous drainage as a final treatment. In 11 (14.9%) patients, video sequestrectomy through the fistula was additionally used to increase efficiency of percutaneous drainage. RESULTS PCD in our modification implies delivery of double-lumen drains 26-32 Fr in the same plane to zones of necrosis, their programmed replacement for prevention of obstruction and flexible endoscopy for control of pathological process. Local purulent-necrotic parapancreatitis occurred in 31 (41.9%) patients, widespread parapancreatitis - in 43 (58.1%) patients. There were 339 minimally invasive interventions. Laparotomy was required in 4 (5.4%) patients. Incidence of perioperative complications was 10.6%, mortality - 16.2%. CONCLUSION A modified percutaneous drainage method may be used as final surgical treatment in 79.7% of patients with infected pancreatic necrosis.
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Affiliation(s)
- S I Remizov
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - A V Andreev
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V M Durleshter
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - S A Gabriel
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - O V Zasyadko
- Kuban State Medical University, Krasnodar, Russia
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Remizov SI, Andreev AV, Durleshter VM, Gabriel SA, Zasyadko OV. [Technological features of open and minimally invasive surgical treatment of local complications of purulent-necrotic pancreatitis]. Khirurgiia (Mosk) 2023:72-79. [PMID: 37379408 DOI: 10.17116/hirurgia202307172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
There are various options for surgical treatment of purulent-necrotic pancreatitis with significant technological differences. Combining surgical methods other than traditional ones into a group of minimally invasive ones based on the principle of the absence of standard laparotomy is not entirely correct. The review presents modern methods of surgical treatment of acute pancreatitis, comparison of their technology regarding classical stages of surgical intervention and their classification.
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Affiliation(s)
- S I Remizov
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - A V Andreev
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V M Durleshter
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - S A Gabriel
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - O V Zasyadko
- Kuban State Medical University, Krasnodar, Russia
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Mao W, Li K, Zhou J, Chen M, Ye B, Li G, Singh V, Buxbaum J, Fu X, Tong Z, Liu Y, Windsor J, Li W, Ke L. Prediction of infected pancreatic necrosis in acute necrotizing pancreatitis by the modified pancreatitis activity scoring system. United European Gastroenterol J 2022; 11:69-78. [PMID: 36579414 PMCID: PMC9892470 DOI: 10.1002/ueg2.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/12/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Infected pancreatic necrosis (IPN) is a significant complication of acute necrotizing pancreatitis (ANP). Early identification of patients at high risk of IPN would enable appropriate treatment, but there is a lack of valid tools. This study aimed to assess the performance of the Pancreatitis Activity Scoring System (PASS) and its modifications (by removing or reducing the weight of opioid usage) in predicting IPN in a cohort of predicted severe ANP patients. METHODS Data was prospectively collected in the TRACE trial (2017-2020) involving 16 sites across China. The predictive performance of PASS, modified PASS (mPASS), and conventional indices were assessed by the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow Ĉ-test, Brier score, and Fagan's nomogram. Multivariate logistic regression analysis (MLRA) was used to define the relationship between the best-performing PASS/mPASS model and IPN. RESULTS A total of 508 subjects were enrolled (median age, 43 years; 62.8% males) in the original trial, and 122 developed IPN (24%) within 90 days after randomization. Compared with non-IPN patients, the scores of PASS and its modified models were significantly higher in the IPN patients (all p < 0.001). Among the PASS and its modifications, mPASS-4 had the largest AUC, the lowest Brier score, and good calibration. The mPASS-4 model demonstrated an AUC of 0.752 in predicting IPN (the optimal cut-off for the mPASS-4 was 292.5) and outperformed the conventional indices. The MLRA results showed that mPASS-4 >292.5 was an independent risk factor of IPN (OR: 3.6, 95% CI: 2.1-6.3). CONCLUSION The PASS and its modifications during the first week of ANP onset predict the development of IPN, with mPASS-4 performing best. The mPASS-4 model simplifies the original PASS, increasing the likelihood of clinical implementation.
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Affiliation(s)
- Wenjian Mao
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Kang Li
- Department of Critical Care MedicineThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jing Zhou
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Miao Chen
- Department of Critical Care MedicineThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Bo Ye
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Gang Li
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Vikesh Singh
- Pancreatitis CentreDivision of GastroenterologyJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - James Buxbaum
- Department of MedicineDivision of GastroenterologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Xiaoyun Fu
- Department of Critical Care MedicineThe Affiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Zhihui Tong
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Yuxiu Liu
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,Department of Medical StatisticsJinling HospitalMedical School of Nanjing UniversityNanjingJiangsuChina
| | - John Windsor
- Surgical and Translational Research CentreFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Weiqin Li
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
| | - Lu Ke
- Department of Critical Care MedicineJinling HospitalNanjing Medical UniversityNanjingJiangsuChina,Department of Critical Care MedicineJinling HospitalMedical College of Nanjing UniversityNanjingJiangsuChina,National Institute of Healthcare Data ScienceNanjing UniversityNanjingJiangsuChina
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Lu J, Ding Y, Qu Y, Mei W, Guo Y, Fang Z, Qu C, Gao C, Cao F, Li F, Feng Y. Risk Factors and Outcomes of Multidrug-Resistant Bacteria Infection in Infected Pancreatic Necrosis Patients. Infect Drug Resist 2022; 15:7095-7106. [PMID: 36483142 PMCID: PMC9725918 DOI: 10.2147/idr.s387384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/18/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE The incidence of acute pancreatitis (AP) is increasing. Twenty percent of AP patients with developing necrotizing pancreatitis (NP), while ~40-70% of NP patients develop potentially fatal infectious complications. When patients are suspected or confirmed infected pancreatic necrosis (IPN), antibiotics should be administered timeously to control the infection, but long-term use of antibiotics can lead to multidrug-resistant bacteria (MDRB) infection and eventually to increased mortality. Our study aimed to determine the incidence of MDRB infection and evaluate the risk factors for MDRB infection in IPN patients. METHODS Clinical data of IPN patients admitted to the general surgery department of Xuanwu Hospital of Capital Medical University between January 1, 2014, and December 31, 2021, were retrospectively analyzed. RESULTS IPN patients (n = 267) were assigned to MDRB infection (n = 124) and non-MDRB infection (n = 143) groups. On admission, patients in the MDRB group had a higher modified computer tomography severity index (CTSI) score (P < 0.05), pancreatic necrosis degree, and PCT level (P < 0.05) than those in the non-MDRB group, and the prognosis of patients in MDRB group was poor. The most common gram-negative bacteria were Acinetobacter baumannii (n = 117), the most common gram-positive bacteria were Enterococcus faecium (n = 98), and the most common fungal infection was Candida albicans (n = 47). Multivariable analysis showed that complications of EPI (OR: 4.116, 95% CI: 1.381-12.271, P = 0.011), procalcitonin (PCT) level at admission (OR: 2.728, 95% CI: 1.502-4.954, P = 0.001), and degree of pancreatic necrosis (OR: 2.741, 95% CI: 1.109-6.775, P = 0.029) were independent risk factors for MDRB infection in IPN patients. CONCLUSION We identified common infectious strains and risk factors for MDRB infection in IPN patients.
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Affiliation(s)
- Jiongdi Lu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yixuan Ding
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuanxu Qu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wentong Mei
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yulin Guo
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhen Fang
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chang Qu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chongchong Gao
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Feng Cao
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fei Li
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yulu Feng
- Department of Pediatric, Chui Yang Liu Hospital Affiliated Tsinghua University, Beijing, People’s Republic of China
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Sui Y, Zhao Z, Zhang Y, Zhang T, Li G, Liu L, Tan H, Sun B, Li L. Fibrinogen-like Protein 1 as a Predictive Marker for the Incidence of Severe Acute Pancreatitis and Infectious Pancreatic Necrosis. Medicina (Kaunas) 2022; 58:medicina58121753. [PMID: 36556955 PMCID: PMC9785826 DOI: 10.3390/medicina58121753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Acute pancreatitis (AP) is defined as an acute inflammatory disorder of the pancreas and is a common gastrointestinal disease. Since currently used indicators lack specifics and cannot accurately reflect the phase of disease, better diagnostic approaches need to be explored. Fibrinogen-like protein 1 (FGL-1) is a reactant in acute inflammatory diseases and is increased in the plasma of AP patients. In the current study, we aim to investigate the clinical benefits of FGL-1 in predicting the severity of AP and infected pancreatic necrosis (IPN), which can improve the diagnostic efficiency of AP. Materials and Methods: In this study, 63 patients diagnosed with AP from December 2018 to September 2019 were enrolled. Regarding the severity of AP, patients were separated into severe acute pancreatitis (SAP, n = 12) and No-SAP groups (n = 51). On the basis of infective conditions, patients were divided into IPN (n = 9) and No-IPN (n = 54) groups. The demographic data (sex and age) and blood parameters (WBC, HCT, glucose, calcium, FIB, APTT, PCT, CRP, and FGL-1) were retrospectively analyzed. Results: The plasma FGL-1 levels were increased in both SAP (p < 0.01) and IPN (p < 0.05) subgroups compared to the healthy control group. Multivariate analysis showed that elevated plasma FGL-1 (p < 0.01) and PCT levels (p < 0.05) within 72 h after the onset of AP were positively correlated with the severity of AP, while increased plasma FGL-1 (p < 0.01) and CRP (p < 0.05) levels were positively correlated with the occurrence of IPN. The combination of FGL-1 and PCT showed superiority to both individual markers in SAP prediction. However, the combination of FGL-1 and CRP showed no diagnostic advantage over CRP in IPN prediction. Conclusions: Plasma FGL-1 within 72 h after the onset could be used for the stratification of AP and its infectious complications. The combination of PCT and FGL-1 presents an enormous advantage for the early identification of SAP.
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Affiliation(s)
- Yuhang Sui
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhongjie Zhao
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yang Zhang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang 550024, China
| | - Tao Zhang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Guanqun Li
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Liwei Liu
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Hongtao Tan
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
- Correspondence: (B.S.); (L.L.)
| | - Le Li
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
- Correspondence: (B.S.); (L.L.)
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13
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Wu D, Jia Y, Cai W, Huang Y, Kattakayam A, Latawiec D, Sutton R, Peng J. Impact of multiple drug-resistant Gram-negative bacterial bacteraemia on infected pancreatic necrosis patients. Front Cell Infect Microbiol 2022; 12:1044188. [PMID: 36506015 PMCID: PMC9731621 DOI: 10.3389/fcimb.2022.1044188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Multiple drug-resistant Gram-negative bacterial (MDR-GNB) bacteraemia poses a serious threat to patients in hospital. Infected pancreatic necrosis (IPN) patients are a vulnerable population to infectious complications during hospitalization. This study aims to evaluate the impact of MDR Gram-negative bacteraemia on IPN patients. Methods A case-control study was performed with data collected from 1 January 2016 to 1 July 2022 in a Chinese tertiary teaching hospital. Clinical data of the IPN patients with MDR-GNB bacteraemia were analyzed and compared to those of a matched control group without MDR-GNB bacteraemia (case-control ratio of 1:2). Comparisons were performed between with/without MDR-GNB bacteraemia and different severities of acute pancreatitis (AP). Independent predictors of overall mortality were identified via univariate and multivariate binary logistic regression analyses. Results MDR-GNB bacteraemia was related to a higher mortality rate (62.5% vs. 8.3%, p < 0.001). Severe AP combined with MDR-GNB bacteraemia further increased mortality up to 81.3% (p = 0.025). MDR-GNB bacteraemia (odds ratio (OR) = 8.976, 95% confidence interval (CI) = 1.805 -44.620, p = 0.007) and severe AP (OR = 9.414, 95% CI = 1.742 -50.873, p = 0.009) were independent predictors of overall mortality. MDR- Klebsiella pneumoniae was the most common causative pathogen. Conclusion A higher mortality rate in IPN patients was related to MDR-GNB bacteraemia and further increased in severe AP patients combined with MDR-GNB bacteraemia.
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Affiliation(s)
- Di Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China,Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Yan Jia
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, United Kingdom,West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yilin Huang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Arjun Kattakayam
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Diane Latawiec
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
| | - Jie Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Jie Peng,
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Li J, Chen Z, Li L, Lai T, Peng H, Gui L, He W. Interleukin-6 is better than C-reactive protein for the prediction of infected pancreatic necrosis and mortality in patients with acute pancreatitis. Front Cell Infect Microbiol 2022; 12:933221. [PMID: 36467730 PMCID: PMC9716459 DOI: 10.3389/fcimb.2022.933221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/12/2022] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION This study aimed to identify whether interleukin-6 (IL-6) is better than C-reactive protein (CRP) for the prediction of severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN), and mortality. METHODS Sixty-seven patients with acute pancreatitis (AP) who were hospitalized within 48 h of onset and received serum CRP and IL-6 tests from September 2018 to September 2019 were included. Spearman's correlation was performed to assess their associations with severity. The areas under the curve (AUCs) for the prediction of SAP, organ failure, pancreatic necrosis, IPN, and mortality were estimated using receiver operating characteristic curves. RESULT Serum CRP and IL-6 levels were significantly positively correlated with the severity of AP (p < 0.05). The AUC for the prediction of SAP based on the CRP level was 0.78 (95% CI, 0.66-0.89) and that based on the IL-6 level was 0.69 (95% CI, 0.56-0.82). For the prediction of organ failure and pancreatic necrosis, CRP was more accurate than IL-6 (AUC 0.80 vs. 0.72 and 0.75 vs. 0.68, respectively). However, CRP was less accurate than IL-6 for predicting mortality and IPN (AUC 0.70 vs. 0.75 and 0.65 vs. 0.81, respectively). Systemic inflammatory response syndrome plus CRP was more accurate than systemic inflammatory response syndrome plus IL-6 (AUC 0.79 vs. 0.72) for the prediction of SAP. CONCLUSIONS IL-6 was more accurate than CRP for predicting mortality and IPN in patients with AP.
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Affiliation(s)
| | | | | | | | | | | | - Wenhua He
- Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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15
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Ding L, He C, Li X, Huang X, Lei Y, Ke H, Chen H, Yang Q, Cai Y, Liao Y, He W, Xia L, Xiong H, Lu N, Zhu Y. Efficacy and Safety of Faecal Microbiota Transplantation for Acute Pancreatitis: A Randomised, Controlled Study. Front Med (Lausanne) 2022; 8:772454. [PMID: 35083238 PMCID: PMC8784600 DOI: 10.3389/fmed.2021.772454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
Aims: We investigated whether faecal microbiota transplantation (FMT) decreases intra-abdominal pressure (IAP) and improves gastrointestinal (GI) dysfunction and infectious complications in acute pancreatitis (AP). Methods: In this first randomised, single-blind, parallel-group, controlled study, we recruited and enrolled consecutive patients with AP complicated with GI dysfunction. Eligible participants were randomly assigned to receive faecal transplant (n = 30) or normal saline (n = 30) via a nasoduodenal tube once and then again 2 days later. The primary endpoint was the rate of IAP decline; secondary endpoints were GI function, infectious complications, organ failure, hospital stay and mortality. Analyses were based on intention to treat. Results: We enrolled 60 participants and randomly assigned them to the FMT (n = 30) or control (n = 30) group. Baseline characteristics and disease severity were similar for both groups. IAP decreased significantly 1 week after intervention in both groups, with no difference in the IAP decline rate between FMT and Control group [0.1 (-0.6, 0.5) vs. 0.2 (-0.2, 0.6); P = 0.27]. Normal gastrointestinal failure (GIF) scores were achieved in 12 (40%) patients in the FMT group and 14 (47%) in the control group, with no significant difference (P = 0.60). However, D-lactate was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [-0.3 (-3.7, 0.8) vs. 0.4 (-1.1, 0.9); P = 0.01]. Infectious complications occurred in 15 (50%) and 16 (53.33%) patients in the FMT and control groups, respectively (P = 0.80). However, interleukin-6 (IL-6) was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [0.4 (-3.6, 0.9) vs. 0.8 (-1.7, 1.0); P = 0.03]. One participant experienced transient nausea immediately after FMT, but no serious adverse events were attributed to FMT. Conclusion: FMT had no obvious effect on IAP and infectious complications in AP patients, though GI barrier indictors might be adversely affected. Further multi-centre studies are needed to confirm our findings. The study was registered at https://clinicaltrials.gov (NCT02318134).
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Affiliation(s)
- Ling Ding
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cong He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xueyang Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xin Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yupeng Lei
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huajing Ke
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongyan Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinyu Yang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Cai
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuanhang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenhua He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Xia
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huifang Xiong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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16
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Remizov SI, Andreev AV, Durleshter VM, Gabriel SA, Levchenko GA. Transfistulous endoscopic sequestrectomy in the treatment of infected pancreatic necrosis. Khirurgiia (Mosk) 2022:23-28. [PMID: 36398951 DOI: 10.17116/hirurgia202211123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To develop an effective minimally invasive method for the treatment of infected pancreatic necrosis. MATERIAL AND METHODS There were 168 patients with infected pancreatic necrosis who were treated at the Regional Clinical Hospital No. 2 between 2011 and 2018. Eighty-seven (51.8%) patients underwent primary drainage with large-diameter double-lumen drains 28-32 Fr, and original technique of transfistulous endoscopic sequestrectomy was used. Puncture-drainage interventions with transfistulous endoscopic sequestrectomy were used in 23 (26.4%) patients with local and 64 (73.6%) patients with widespread purulent-necrotic parapancreatitis. RESULTS Percutaneous channels are accesses to purulent-necrotic cavity and used for transfistulous endoscopic sequestrectomy. This procedure was performed 98 times. Time of primary sanitation in patients with 3 accesses in omental bursa was significantly less compared to 2 accesses (62±4.3 vs. 89±8.2 min, p<0.05). In case of repeated sanitation, time of intervention did not depend on the number of accesses. Incidence of local complications was 9.1%, extra-abdominal complications - 19.4%. Mortality rate was 12.6%. CONCLUSION Original technique of transfistulous endoscopic sequestrectomy increases efficiency of sanitation of infected parapancreatitis, improves treatment outcomes and reduces mortality to 12.3%.
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Affiliation(s)
- S I Remizov
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - A V Andreev
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V M Durleshter
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - S A Gabriel
- Regional Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
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17
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Vinnik YS, Teplyakova OV, Erguleeva AD. [Etiology and pathogenesis of infected pancreatic necrosis]. Khirurgiia (Mosk) 2022:90-97. [PMID: 35920228 DOI: 10.17116/hirurgia202208190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Modern literature data confirm the central role of intestinal barrier complex not only as a target in acute necrotizing pancreatitis, but also as a trigger for septic complications. Intra-abdominal hypertension, endothelial dysfunction and gut microbiome changes following necrotizing pancreatitis might have an independent impact on acute intestinal distress syndrome and bacterial translocation. Monitoring of these conditions and early target therapy can improve the outcomes in patients with severe acute pancreatitis. Adverse outcomes of infected pancreatic necrosis including high mortality and morbidity are largely due to the prevalence of multidrug-resistant bacterial pathogens.
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Affiliation(s)
- Yu S Vinnik
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - O V Teplyakova
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - A D Erguleeva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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18
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Yin J, Mao W, Xiao X, Yu X, Li B, Chen F, Lin J, Zhou J, Zhou J, Tong Z, Ke L, Li W. Immune Dysfunction is Associated with Readmission in Survivors of Sepsis Following Infected Pancreatic Necrosis. J Inflamm Res 2021; 14:5433-5442. [PMID: 34707384 PMCID: PMC8542572 DOI: 10.2147/jir.s321507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Immunosuppression is common in patients with infected pancreatic necrosis (IPN) and associated with morbidity and mortality. This study aimed to investigate the impact of immune status on mortality and readmission after hospital discharge in patients with IPN-related sepsis. Methods In this prospective observational study, eligible adult patients with IPN-related sepsis requiring ICU admission were included. Monocytic human leukocyte antigen DR (mHLA-DR), expression of regulatory T cells (Treg), and neutrophil CD88 (nCD88) were measured on the diagnosis of sepsis, ICU discharge, hospital discharge, and 15, 30, 60 days after hospital discharge. Logistic regression model was used to assess potential risk factors for readmission 60-days within the index discharge. Results A total of 53 patients were included, 13 died during hospitalization and one withdrew the consent soon after discharge. Among the survivors, a tendency of immune recovery was observed during the consecutive follow-ups, evidenced by the increased expression of mHLA-DR. Sixteen patients (41.03%) were readmitted within 60 days after the index discharge. In the multivariable regression model, APACHE II score when sepsis was diagnosed >9 and mHLA-DR at discharged <14,591 AB/C were found to be independent risk factors affecting readmission. Conclusion Immunosuppression is common in patients with IPN-related sepsis and can persist until two months after discharge. The compromised mHLA-DR level at discharge was associated with readmission within two months after discharge.
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Affiliation(s)
- Jiangtao Yin
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Intensive Care Unit, Affiliated Hospital of Jiangsu University, Zhenjiang, People's Republic of China
| | - Wenjian Mao
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaojia Xiao
- Department of Critical Care Medicine, Jinling Hospital of Southern Medical University, Nanjing, People's Republic of China
| | - Xianqiang Yu
- Southeast University School of Medicine, Nanjing, People's Republic of China
| | - Baiqiang Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Faxi Chen
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jing Zhou
- Southeast University School of Medicine, Nanjing, People's Republic of China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Critical Care Medicine, Jinling Hospital, Nanjing University, Nanjing, People's Republic of China
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Hao H, Liu Y, Cao J, Gao K, Lu Y, Wang W, Wang P, Lu S, Hu L, Tong Z, Li W. Genomic New Insights Into Emergence and Clinical Therapy of Multidrug-Resistant Klebsiella pneumoniae in Infected Pancreatic Necrosis. Front Microbiol 2021; 12:669230. [PMID: 34248878 PMCID: PMC8269854 DOI: 10.3389/fmicb.2021.669230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Infected pancreatic necrosis (IPN) is a key risk factor in the progression of severe acute pancreatitis, and use of antibiotics is one of the main clinical actions. However, early prophylactic or unreasonable use of antibiotics promotes drug resistance in bacteria and also delays optimum treatment. To explore genomic evidence of rational antibiotic use in intensive care units, we isolated Klebsiella pneumoniae from IPN samples that showed the highest positive-culture rate in 758 patients. Based on whole-genome sequencing from eight strains, 42 antibiotic-resistant genes were identified in the chromatin and 27 in the plasmid, which included classic resistance-mechanism factors such as β-lactamases [16.67% (7/42) in the chromatin and 25.93% (7/27) in the plasmid]. The K. pneumoniae isolates were identified to be resistant to multiple antibiotics used in clinics. In vivo and in vitro, ceftazidime-avibactam (CZA) plus aztreonam (ATM) (2.5:1) showed more significant antibacterial effectiveness than CZA alone. The isolated K. pneumoniae were of three different types according to the resistance phenotypes for CZA and ATM. Those co-harboring bla NDM-5, bla CTX-M-15, bla OXA-1, and bla SHV-187 showed higher resistance to CAZ than bla NDM-5. Those co-harboring bla CTX-M-65, bla SHV-182, and bla TEM-181 were significantly less resistant to β-lactam than to other extended-spectrum β-lactamases. However, β-lactamases were inhibited by avibactam (AVI), except for NDM-5. ATM plus AVI showed a significant inhibitory effect on K. pneumoniae, and the minimum dosage of ATM was < 1 mg/L. In conclusion, we propose that ATM plus AVI could be a major therapy for complex infectious diseases caused by multidrug-resistant K. pneumoniae.
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Affiliation(s)
- Haibin Hao
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Liu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jin Cao
- Laboratory of Microbiology, Basic Medical Laboratory, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Kun Gao
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,School of Medicine, Nanjing Medical University, Nanjing, China
| | - Yingying Lu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Weiping Wang
- Laboratory of Microbiology, Basic Medical Laboratory, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Peng Wang
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sida Lu
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Long Hu
- Department of Bioinformatics, Hugobiotech Co., Ltd., Beijing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,National Institut of Healthcare Data Science at Nanjing University, Nanjing, China.,State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
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Akayzin ES, Akayzina AE. Indicators of volatile fatty acids for differential diagnostics of nfected of pancreatic necrosis complicated by retroperitoneal phlegmon. Klin Lab Diagn 2021; 66:310-314. [PMID: 34047518 DOI: 10.51620/0869-2084-2021-66-5-310-314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of the study was to assess the informative value of volatile fatty acid parameters for the differential diagnosis of infected pancreatic necrosis (IPN), complicated by retroperitoneal cellulitis. The work was based on the results of examination and treatment of 44 patients with infected pancreatic necrosis. The analysis of concentrations of volatile fatty acids: acetic, propionic, butyric and isovalerianic was carried out on a Kristallux-4000 automated gas chromatograph with an HP-FFAP capillary column and a flame ionization detector. The indicators of acetic acid and the amount of volatile fatty acids were statistically significantly higher in patients with infected pancreatic necrosis with total retroperitoneal phlegmons in comparison with the indicators of volatile fatty acids in patients with infected pancreatic necrosis with paracolic phlegmons and in comparison with indicators of volatile fatty acids in patients with infected pancreatic necrosis phlegmons. The indicators of acetic acid and the amount of VFA can be used as additional criteria for the differential diagnosis of IPN complicated by phlegmons of the retroperitoneal tissue.
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21
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Kim YJ, Cho E, Park CH. Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer: A case report. Medicine (Baltimore) 2021; 100:e25466. [PMID: 33879679 PMCID: PMC8078367 DOI: 10.1097/md.0000000000025466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears. PATIENT CONCERNS A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever. DIAGNOSES The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN. INTERVENTIONS AND OUTCOMES EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy. LESSONS In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.
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22
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Mohapatra N, Sasturkar SV, Falari S, Sandhyav R, Kumar N, Agrawal N, Arora A, Pamecha V, Chattopadhyay TK. Strategic approach to minimally invasive necrosectomy for necrotizing pancreatitis: technique, complications and predictors of outcome. ANZ J Surg 2021; 91:E104-E111. [PMID: 33522687 DOI: 10.1111/ans.16619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive retroperitoneal necrosectomy has been an integral component of 'step-up' approach for infected pancreatic necrosis. Even though the clinical outcome of nephroscopic necrosectomy has been studied earlier, its predictor and morbidities following surgery have not been extensively evaluated. We aimed to evaluate the clinical outcome and early and late complications after percutaneous nephroscopic necrosectomy (PCNN). METHODS The pre- and intra-operative as well as post-operative and follow-up data of severe pancreatitis patients undergoing PCNN were collected prospectively. RESULTS Out of 115 patients requiring intervention, 40 patients (34.78%) improved with percutaneous drain alone and another 40 proceeded for PCNN. After exclusion, 37 patients successfully underwent 48 sessions of PCNN. Median number of PCNN session was 1 (1-4). Early complications were seen in 21 (56.75%) patients and mortality was experienced in eight (21.62%) patients. On median follow-up of 36 months, 12 (32.43%) patients experienced late complications. Persistent post-operative pancreatic fistula was observed in six (16.21%) patients. Of these, three developed late-onset pseudocyst, whereas one patient had disconnected duct syndrome. Seven patients experienced new-onset diabetes. Age, severity of pancreatitis, preoperative organ failure and multiorgan failure were significant predictors of mortality on univariate analysis (P ≤ 0.05 for each). The logistic regression analysis revealed presence of multiorgan failure before surgery as the sole predictor (P = 0.007; odds ratio 10.417; 95% confidence interval 1.759-61.672). CONCLUSION Preoperative multiorgan failure was the most important predictor of mortality following PCNN. Late complications were seen in nearly one-third of patients emphasizing the need for long-term follow-up.
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Affiliation(s)
- Nihar Mohapatra
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shridhar V Sasturkar
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sanyam Falari
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rommel Sandhyav
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Niteen Kumar
- Department of HPB Surgery and Liver Transplantation, BLK Super Speciality Hospital, New Delhi, India
| | - Nikhil Agrawal
- Department of Gastrointestinal and HPB Surgical Oncology, Max Super Speciality Hospital Saket, New Delhi, India
| | - Asit Arora
- Department of Gastrointestinal and HPB Surgical Oncology, Max Super Speciality Hospital Saket, New Delhi, India
| | - Viniyendra Pamecha
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Tushar K Chattopadhyay
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
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Rebhun J, Nassani N, Pan A, Hong M, Shuja A. Outcomes of Open, Laparoscopic, and Percutaneous Drainage of Infected Walled-Off Pancreatic Necrosis: A Nationwide Inpatient Sample Study. Cureus 2021; 13:e12972. [PMID: 33654633 PMCID: PMC7913891 DOI: 10.7759/cureus.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Walled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN. Methods Using the Nationwide Inpatient Sample (NIS), patients aged 18 years and older discharged with the diagnosis of WOPN between January 1, 2016 and December 31, 2016 who underwent open, laparoscopic, or percutaneous drainage were included. Patients’ characteristics including age, gender, and body mass index were reported. The primary endpoints were the mortality rate as well as length and cost of stay in each group. The secondary endpoint was the rate of procedural complications in each arm. Endpoints were reported and compared with studies assessing similar outcomes. Statistical Analysis System (SAS) statistical software (SAS Institute Inc., Cary, NC, USA) was used to perform the analysis. Results A total of 229 patients with the diagnosis of acute pancreatitis with infected necrosis were identified. Of these 229 patients, 27, 15, and 20 underwent open, laparoscopic, and percutaneous drainage, respectively. A total of eight studies were used for comparison of outcome variables. Mortality rate was found to be similar among comparison studies. LOS and costs varied widely among studies. There were significantly fewer pancreatic fistula and significantly more multi-organ failure complications as a result of open necrosectomy in the NIS study sample. Conclusion Overall, in analyzing the outcomes of patients undergoing intervention for infected WOPN through the 2016 NIS database, it appears that the database is representative of the majority of outcomes seen in similar clinical trials.
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Affiliation(s)
- Jeffrey Rebhun
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Najib Nassani
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Alex Pan
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Mindy Hong
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Asim Shuja
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
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Li J, Zhu S, Cao X, Lin C, Ning C, Huang G. Classification of emphysematous pancreatitis and its relation to prognosis. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2020; 45:1348-1354. [PMID: 35753750 DOI: 10.11817/j.issn.1672-7347.2020.200678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Emphysematous pancreatitis (EP) is a subtype of infectious pancreatic necrosis (IPN). It is characterized by the accumulation of gas inside or around the pancreatic necrotic tissue. This study aims to investigate the relation between classification and prognosis of EP, and to provide guidance for clinical diagnosis and treatment of IPN. METHODS A prospective cohort of 228 cases of IPN from January 2010 to June 2020 in the Department of General Surgery of Xiangya Hospital, Central South University were analyzed. Among them, 120 cases without peritoneal/retroperitoneal surgical intervention before admission were included. The 120 cases of IPN were classified into the EP group and the non-EP group. The general clinical information and results of pathogenic microorganism between the EP and the non-EP group were compared. EP patients were divided into early-EP (within 2 weeks of onset) and late-EP (after 2 weeks of onset) according to the presence timing of air bubble sign, and they were divided into extensive-EP and common-EP according to the distribution characteristics of bubble sign. The clinical characteristics between the survivors and non-survivors of both IPN and EP were compared. RESULTS Among the 120 IPN patients, 25 (20.8%) were EP patients and 95 (79.2%) were non-EP patients. According to the classifications, 8 were early-EP (32.0%) and 17 were late-EP (68.0%); 15 were common-EP (60.0%) and 10 were extensive-EP (40.0%). There was no significant difference in gender, age, etiology, and mortality between the EP group and the non-EP group (all P>0.05). The percentage of Escherichia coli infection in the EP group was significantly higher than that in non-EP group (52.0% vs 16.5%, P<0.05). Among the 120 IPN patients, 35 died (IPN non-survivors) and 85 patients survived (IPN survivors). The mortality rate of IPN was 29.2%. There was no significant difference in gender, age, and etiology between the IPN non-survivors and the IPN survivors (all P>0.05). The proportion of severe patients in IPN non-survivors was significantly higher than that in the IPN survivors (97.1% vs 54.1%, P<0.05). Among the 25 cases of EP, 8 died (EP non-survivors) and 17 survived (EP survivors). The mortality rate of EP was 32.0%. There was no significant difference in gender, age, etiology, and time from gas detected to surgical intervention between the EP non-survivors and the EP survivors (all P>0.05). The proportion of early-EP and extensive-EP in the EP non-survivors was significantly higher than that in the EP survivors (both P<0.05). The mortality was up to 100% in the early- and extensive-EP patients. All of the EP non-survivors were severe patients, while 58.8% of the EP survivors were moderate or severe patients, the difference was statistically significant (P<0.05). All of the EP survivors underwent step-up surgical treatment strategy. CONCLUSIONS Air bubble sign is not associated with the prognosis of IPN. Early- and extensive-EP often indicate worse prognosis. Aggressive surgical intervention based on step-up approach should be considered with priority.
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Affiliation(s)
- Jiarong Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Shuai Zhu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xintong Cao
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chiayen Lin
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Caihong Ning
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Gengwen Huang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
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25
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Zhang JB, Sun B. Comparison between video-assisted retroperitoneal debridement and small incision pancreatic necrosectomy in infected pancreatic necrosis. ANZ J Surg 2020; 90:2020-2025. [PMID: 32783340 DOI: 10.1111/ans.16181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Debridement and drainage have always been mainstream treatment for infected pancreatic necrosis (IPN), and the application of minimally invasive necrosectomy is becoming increasingly widespread. However, few studies have compared video-assisted retroperitoneal debridement (VARD) and small incision pancreatic necrosectomy (SIPN) individually. Our aim was to compare VARD and SIPN by evaluating outcomes. METHODS We retrospectively reviewed patients with IPN who underwent either VARD or SIPN between 2010 and 2019 in China. Data relative to patient demographics, major complications, health care resource utilization and mortality were collected. Statistical analyses used were the two-tailed Student's t-test and the chi-squared test. RESULTS Of 59 patients, 31 patients underwent SIPN and 28 patients were treated with VARD. SIPN and VARD had similar treatment success and mortality rates. The rate of reintervention due to lack of clinical improvement was significantly lower in the SIPN group (32% versus 61%; P = 0.028). In addition, the length of total hospital stay was 60 days in the SIPN group and 72 days in the VARD group (P < 0.0001) and mean total costs was significantly less in the SIPN group than in the VARD group (P = 0.008). CONCLUSION Given the shorter hospitalization period, lower total cost and lower rate of reinterventions, SIPN may be superior to the step-up approach for patients with IPN than for those with VARD.
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Affiliation(s)
- Jin-Bao Zhang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, China
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Budkule D, Desai G, Pande P, Narkhede R, Wagle P, Varty P. An outcome analysis of videoscopic assisted retroperitoneal debridement in infected pancreatic necrosis: a single centre experience. Turk J Surg 2020; 35:214-222. [PMID: 32550331 DOI: 10.5578/turkjsurg.4289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/10/2018] [Indexed: 11/15/2022]
Abstract
Objectives Infected pancreatic necrosis (IPN) is a dreadful complication of moderately severe and severe acute necrotising pancreatitis (ANP). Videoscopic assisted retroperitoneal debridement (VARD) is a minimally invasive surgical option for predominantly left sided, posterior and laterally located disease in patients not responding to conservative and percutaneous options. This study aimed to present an outcome analysis of VARD in the management of IPN at our tertiary care centre. Material and Methods The present retrospective analysis of prospectively entered data included 22 patients diagnosed as ANP with IPN from January 2015 to December 2017. These patients were admitted in the surgical gastroenterology unit of our tertiary care centre. The outcome of these patients managed with VARD was evaluated. Results The aetiology of ANP was idiopathic, and gallstones were found in 7 patients each and alcohol in 8. Twelve patients were managed with a single VARD procedure; whereas, 10 required a re-debridement due to suboptimal improvement. Eighteen out of 22 patients survived whereas 4 succumbed to major postoperative bleeding/severe sepsis and multiorgan failure (Mortality 18.2%). Hospital stay after the index procedure was between 6 to 11 weeks. Conclusion VARD is a safe and effective surgical option for the management of IPN that worsens or fails to respond to conservative and percutaneous drainage options after a minimum of 4 weeks of moderately severe and severe ANP. It decreases postoperative morbidity and mortality and avoids major laparotomy, and hence, it can be considered in a selected group of patients.
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Affiliation(s)
- Dattaraj Budkule
- Clinic of General Surgery and Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Gunjan Desai
- Clinic of General Surgery and Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Prasad Pande
- Clinic of General Surgery and Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Rajvilas Narkhede
- Clinic of General Surgery and Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Prasad Wagle
- Clinic of General Surgery and Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Paresh Varty
- Clinic of General Surgery and Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
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Gallyamov EA, Agapov MA, Busyrev YB, Gallyamov EE, Kakotkin VV, Allakhverdieva AR. [Comparison of minimal invasive technologies for treatment of infected pancreatic necrosis]. Khirurgiia (Mosk) 2020:22-28. [PMID: 32271733 DOI: 10.17116/hirurgia202003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM the assessment of the role of minimally invasive interventional procedures in the treatment of patients with infected pancreatic necrosis and their safety, as well as comparison of the results of the most common modern minimally invasive techniques among themselves. METHODS The results of treatment of 310 patients are presented with infected destructive pancreatitis from 2013 to 2018 on the basis of the city clinical hospital named after I.V. Davydovsky. The patients were divided into three groups: in the first one (n=170) patients underwent puncture followed by drainage of necrotic foci under ultrasound and CT control, in the second (n=98) patients underwent sanation of foci completely by laparoscopic access, in the third (n=42) a series of retroperitoneoscopy was used for the same purpose. RESULTS In 114 (67.1%) cases, patients from the first group did not require further surgical intervention. The results of percutaneous drainage were successful. The average length of hospital stay in the first group was 27 days, in the second and third groups - 31 days (the ratio in the 2nd and 3rd groups was 1.03 (95% CI 0.97-1.08; p<0.05)). In the course of treatment, complications were identified in 35 (35.7%) patients in the 2nd and 17 (40.4%) patients in the 3rd group (ratio 0.88 (95% CI 0.82-0.94)). There were 22 (7.1%) deaths. The causes of death were: 1 (0.3%) of the patient had arrosive bleeding, 2 (0.7%) had duodenal fistulas, 19 (6.1%) multiple organ failure against the background of widespread retroperitoneal phlegmon. CONCLUSION The efficacy of treatment of infected pancreatic necrosis depends on the possibility of full drainage of the necrotic focus, regardless of approach. Minimally invasive techniques can reduce intraoperative trauma by reducing the wound surface, which contribute to develop systemic inflammatory response syndrome.
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Affiliation(s)
- E A Gallyamov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - M A Agapov
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia
| | - Yu B Busyrev
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - E E Gallyamov
- Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - V V Kakotkin
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia
| | - A R Allakhverdieva
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia
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Glabai VP, Gridnev OV, Bashankaev BN, Bykov AN, Krylov AV, Kaprin IA, Eldarova ZE, Variasova AA. [Surgical strategy for acute biliary pancreatitis]. Khirurgiia (Mosk) 2019:37-41. [PMID: 31714528 DOI: 10.17116/hirurgia201911137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.
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Affiliation(s)
- V P Glabai
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russia Moscow, Russia
| | - O V Gridnev
- Konchalovsky Municipal Clinical Hospital, Moscow, Russia
| | - B N Bashankaev
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russia Moscow, Russia
| | - A N Bykov
- Konchalovsky Municipal Clinical Hospital, Moscow, Russia
| | - A V Krylov
- Konchalovsky Municipal Clinical Hospital, Moscow, Russia
| | - I A Kaprin
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russia Moscow, Russia
| | - Z E Eldarova
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russia Moscow, Russia
| | - A A Variasova
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russia Moscow, Russia
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Abstract
INTRODUCTION Severe acute pancreatitis (SAP) is an acute inflammatory disease with prolonged clinical course, which is complicated by the presence of persistent organ failure and severe infection. Infection mainly occurs in the late phase of SAP and it is found to be the main cause of death. Therefore, developing strategies for the prevention of SAP-related infection has been a crucial approach to improve patients' outcomes. Due to remarkable immune-cells-regulating properties, thymosin α1 has been recognized as a promising immune therapy, especially in several infectious diseases. Recently, thymosin α1 has been given high expectations to exert clinical benefits in the prevention of SAP-related infection. AREAS COVERED The review of currently available strategies for SAP-related infection prevention and the use of thymosin α1 in SAP patients. EXPERT OPINION The current available strategies achieve limited success for preventing SAP-related infection. A possible explanation is that the trigger of infection, immunosuppression has not been concurrently resolved. The application of thymosin α1 in a clinical study showed a prophylactic effect against SAP-related infection. However, the use of thymosin α1 in SAP patients is still at an early stage of clinical investigation and requires high-quality and large sample size evidences.
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Affiliation(s)
- Na Yang
- a Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Lu Ke
- a Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Zhihui Tong
- a Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
| | - Weiqin Li
- a Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital , Medical School of Nanjing University , Nanjing , China
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Garret C, Péron M, Reignier J, Le Thuaut A, Lascarrou JB, Douane F, Lerhun M, Archambeaud I, Brulé N, Bretonnière C, Zambon O, Nicolet L, Regenet N, Guitton C, Coron E. Risk factors and outcomes of infected pancreatic necrosis: Retrospective cohort of 148 patients admitted to the ICU for acute pancreatitis. United European Gastroenterol J 2018; 6:910-918. [PMID: 30023069 DOI: 10.1177/2050640618764049] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/10/2018] [Indexed: 12/18/2022] Open
Abstract
Objective The primary objective of this article is to identify risk factors for infected pancreatic necrosis (IPN) in patients admitted to the intensive care unit (ICU) for severe acute pancreatitis. We also described outcomes of IPN. Background Acute pancreatitis is common and associated with multiple, potentially life-threatening complications. Over the last decade, minimally invasive procedures have been developed to treat IPN. Methods We retrospectively studied consecutive patients admitted for severe acute pancreatitis to the ICUs of the Nantes University Hospital in France, between 2012 and 2015. Logistic regression was used to evaluate potential associations linking IPN to baseline patient characteristics and outcomes. Results Of the 148 included patients, 26 (17.6%) died. IPN developed in 62 (43%) patients and consistently required radiological, endoscopic, and/or surgical intervention. By multivariate analysis, factors associated with IPN were number of organ failure (OF) (for ≥ 3: OR, 28.67 (6.23-131.96), p < 0.001) and portosplenomesenteric venous thrombosis (OR, 8.16 (3.06-21.76)). Conclusion IPN occurred in nearly half our ICU patients with acute pancreatitis and consistently required interventional therapy. Number of OFs and portosplenomesenteric venous thrombosis were significantly associated with IPN. Early management of OF may reduce IPN incidence, and management of portosplenomesenteric venous thrombosis should be investigated.
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Affiliation(s)
- Charlotte Garret
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Matthieu Péron
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Frédéric Douane
- Radiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marc Lerhun
- Institut des Maladies de l'Appareil Digestif, F-44093, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Isabelle Archambeaud
- Institut des Maladies de l'Appareil Digestif, F-44093, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Noëlle Brulé
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Cédric Bretonnière
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Olivier Zambon
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Laurent Nicolet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Nicolas Regenet
- Institut des Maladies de l'Appareil Digestif, F-44093, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christophe Guitton
- Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, F-44093, Centre Hospitalier Universitaire de Nantes, Nantes, France
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Windsor JA, Escott A, Brown L, Phillips AR. Novel strategies for the treatment of acute pancreatitis based on the determinants of severity. J Gastroenterol Hepatol 2017; 32:1796-1803. [PMID: 28294403 DOI: 10.1111/jgh.13784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis (AP) is a common disease for which a specific treatment remains elusive. The key determinants of the outcome from AP are persistent organ failure and infected pancreatic necrosis. The prevention and treatment of these determinants provides a framework for the development of specific treatment strategies. The gut-lymph concept provides a common mechanism for systemic inflammation and organ dysfunction. Acute and critical illness, including AP, is associated with intestinal ischemia and drastic changes in the composition of gut lymph, which bypasses the liver to drain into the systemic circulation immediately proximal to the major organ systems which fail. The external diversion of gut lymph and the targeting of treatments to counter the toxic elements in gut lymph offers novel approaches to the prevention and treatment of persistent organ failure. Infected pancreatic necrosis is increasingly treated with less invasive techniques, the mainstay of which is drainage, both endoscopic and percutaneous. Further improvements will occur with the strategies to accelerate liquefaction and through a fundamental re-design of drains, both of which will increase drainage efficacy. The determinants of severity and outcome in patients admitted with AP provide the basis for innovative treatment strategies. The priorities are to translate the gut-lymph concept to clinical practice and to improve the design and active use of drains for infected complications of AP.
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Affiliation(s)
- John A Windsor
- Pancreas Research Group, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alistair Escott
- Pancreas Research Group, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa Brown
- Pancreas Research Group, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Rj Phillips
- Pancreas Research Group, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Topuzov EE, Balashov VK, Tsatinyan BG, Arshba EA, Petryashеv AV, Bobrakov MA. [Surgical treatment of acute pancreatitis: possibilities of percutaneous therapy]. Khirurgiia (Mosk) 2017:91-94. [PMID: 28805786 DOI: 10.17116/hirurgia2017891-94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- E E Topuzov
- Oppel Department of Hospital Surgery, Mechnikov North-West State Medical University, Health Ministry of Russia, St. Petersburg, Russia
| | - V K Balashov
- Oppel Department of Hospital Surgery, Mechnikov North-West State Medical University, Health Ministry of Russia, St. Petersburg, Russia
| | - B G Tsatinyan
- Oppel Department of Hospital Surgery, Mechnikov North-West State Medical University, Health Ministry of Russia, St. Petersburg, Russia
| | - E A Arshba
- Oppel Department of Hospital Surgery, Mechnikov North-West State Medical University, Health Ministry of Russia, St. Petersburg, Russia
| | - A V Petryashеv
- Oppel Department of Hospital Surgery, Mechnikov North-West State Medical University, Health Ministry of Russia, St. Petersburg, Russia
| | - M A Bobrakov
- Oppel Department of Hospital Surgery, Mechnikov North-West State Medical University, Health Ministry of Russia, St. Petersburg, Russia
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Abstract
To assess the association between the clinical parameters within 48 hours of admission and the occurrence of infected pancreatic necrosis (IPN) during the late phase of necrotizing pancreatitis (NP).All patients were divided into 2 groups, the IPN and non-IPN groups. The clinical data were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between clinical parameters and IPN secondary to NP. The performance of each independent variable was plotted by the receiver-operating characteristic (ROC) curve. Consequently, the cut-off level of each independent variable with its sensitivity and specificity was calculated.A total of 215 patients were enrolled in our study. Among them, 87 (40.5%) patients developed IPNs after a median of 13.5 (9.5-23.0) days from admission. Multivariate analysis indicated that the level of hematocrit (HCT) from 40% to 50% (P=.012, odds ratio (OR) = 2.407), HCT over 50% (P < .009, OR = 6.794), blood urea nitrogen (BUN) (P = .040, OR = 1.894), C-reactive protein (CRP) (P = .043, OR = 1.837), and procalcitonin (PCT) (P = .002, OR = 2.559) were independent risk factors of IPN secondary to NP. The ROC cures revealed that the area under the ROC (AUC) of the maximum level of HCT, BUN, CRP, and PCT within 48 hours of admission was 0.687, 0.620, 0.630, and 0.674 respectively. Furthermore, the combination of these 4 individual parameters contributes to a more preferable AUC of 0.789 with a sensitivity of 67.8% and specificity of 77.3%.The maximum levels of PCT, CRP, HCT, and BUN within 48 hours of admission are independent factors of IPN and their combination might accurately predict the occurrence of IPN secondary to NP.
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Rasslan R, da Costa Ferreira Novo F, Rocha MC, Bitran A, de Souza Rocha M, de Oliveira Bernini C, Rasslan S, Utiyama EM. Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone. Clinics (Sao Paulo) 2017; 72:87-94. [PMID: 28273241 PMCID: PMC5314426 DOI: 10.6061/clinics/2017(02)04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/18/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE: To present our experience in the management of patients with infected pancreatic necrosis without drainage. METHODS: The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed. RESULTS: We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died. CONCLUSIONS: In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.
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Affiliation(s)
- Roberto Rasslan
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
- *Corresponding author. E-mail:
| | - Fernando da Costa Ferreira Novo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
| | - Marcelo Cristiano Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
| | - Alberto Bitran
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
| | - Manoel de Souza Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Radiologia e Oncologia, São Paulo/SP, Brazil
| | - Celso de Oliveira Bernini
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
| | - Samir Rasslan
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
| | - Edivaldo Massazo Utiyama
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Cirurgia - Disciplina de Cirurgia Geral e Trauma, São Paulo/SP, Brazil
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Jacob AO, Stewart P, Jacob O. Early surgical intervention in severe acute pancreatitis: Central Australian experience. ANZ J Surg 2014; 86:805-810. [PMID: 24890051 DOI: 10.1111/ans.12707] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Severe acute pancreatitis (SAP) is a disease associated with a high mortality and morbidity; however, many patients survive due to better understanding of the disease and multidisciplinary care. Those who do not respond to intensive care management with persistent multi-organ dysfunction still have a high mortality. There is a role for early surgical intervention in two subsets of critically ill patients: the first, with acute compartment syndrome (ACS) of the abdomen with persisting organ dysfunction despite medical measures to control intra-abdominal pressure; the second, being early infected pancreatic necrosis (IPN) with the presence of gas in the retroperitoneum. METHODS The current analysis is an 8-year (2005-2012) study. The data were collected prospectively by the Surgical Department in Alice Springs Hospital. Intensive care data were also sourced from ANZICS CORE (Australia and New Zealand Intensive Care Society and Centre for Outcome and Resource Evaluation) for ICU (intensive care unit) mortality comparison between ICUs of Australia and New Zealand with Alice Springs. RESULTS There were 1163 episodes of acute pancreatitis with an annual incidence of 275 per 100 000. Of importance, 114 patients had SAP of whom 42 developed pancreatic necrosis. Eleven patients required surgical intervention. Five patients had decompressive laparotomies for ACS and six patients had laparotomies for IPN. The mortality of patients with SAP was 0%. CONCLUSIONS The two subsets of patients with either ACS or early IPN require early surgical intervention either by decompressive laparotomy or open necrosectomy with laparostomy. The authors attribute improved survival in this cohort due to these interventions.
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Affiliation(s)
- Abraham O Jacob
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
| | - Penny Stewart
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Ollapallil Jacob
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Szeliga J, Jackowski M. Minimally invasive procedures in severe acute pancreatitis treatment - assessment of benefits and possibilities of use. Wideochir Inne Tech Maloinwazyjne 2014; 9:170-8. [PMID: 25097683 DOI: 10.5114/wiitm.2014.41628] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/24/2013] [Accepted: 10/14/2013] [Indexed: 12/29/2022] Open
Abstract
Introduction Acute pancreatitis (AP) consists of an extremely varied complex of pathological symptoms and clinical conditions, ranging from mild gastric complaints to multi-organ failure resulting in death. Aim To present the authors’ own experience regarding surgical treatment for pancreatic necrosis complicated by infection using different methods, including classic and laparoscopic methods as well as those combined with percutaneous techniques. Material and methods In the period 2007–2010, 34 patients with the diagnosis of severe AP were treated at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University. In 7 patients classic necrosectomy with repeated peritoneal flushing was performed (type 1), in 5 patients laparotomy with active drainage (type 2), in 12 video-assisted retroperitoneal debridement (type 3), and in 10 only percutaneous drainage methods (type 4). Results Total duration of hospitalisation was from 10 to 192 days. The highest death rate was observed for type 1 procedures. Significant differences with regard to the absolute number of postoperative complications between different groups were not observed; however, their quality varied. Classic methods were used in patients whose general and local condition was more severe. Conclusions When AP and its complications are diagnosed, a suitable method of surgical treatment has to be selected extremely precisely and in an individualised way. Minimally invasive methods used in selected patients provide better outcomes and higher safety superseding classic, open techniques of surgical treatment.
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Wysocki L, Wroński M, Cebulski W, Krasnodębski IW. Combined minimally invasive management of infected pancreatic necrosis: a case report. Wideochir Inne Tech Maloinwazyjne 2014; 9:107-9. [PMID: 24729819 DOI: 10.5114/wiitm.2014.40989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/27/2013] [Accepted: 05/16/2013] [Indexed: 01/10/2023] Open
Abstract
Infected necrosis is a potentially fatal complication of necrotizing pancreatitis. Open surgical debridement is the mainstay management of infected pancreatic necrosis. Over the last decade minimally invasive techniques have been increasingly used for the treatment of infected pancreatic necrosis and their results are encouraging. However, the optimal technique of minimal access necrosectomy and the timing of intervention have not been established yet. Patients with septic complications of acute pancreatitis represent a challenging group which requires individualized management often involving numerous techniques. We report a case of a 52-year-old patient in whom 3 minimally invasive techniques were needed for complete recovery.
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