BACKGROUND: Severe acute pancreatitis(SAP) remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis(IPN), a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS: The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic(ROC) curve was created for each of the qualified independent risk factors. RESULTS: Of the 115 eligible patients, 39(33.9%) progressed to IPN, and the overall in-hospital mortality was 11.3%(13/115).The early enteral nutrition(EEN)(P=0.0092, OR=0.264), maximum intra-abdominal pressure(IAP)(P=0.0398, OR=1.131)and maximum D-dimer level(P=0.0001, OR=1.006) in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve(AUC) was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS: The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.
Liang JiJia-Chen LvZeng-Fu SongMai-Tao JiangLe LiBei Sun
目的重症急性胰腺炎(SAP)的治疗始终是国内外学者关注的热点话题,纵观SAP的诊治发展史,其治疗观念呈现着曲折式前进的态势。随着微创理念的发展,SAP的外科治疗方式发生了很大的变化,尤其在治疗晚期感染性胰腺坏死(IPN)时,传统的开腹清创引流术逐渐被经皮穿刺引流、内镜、腹腔镜等微创技术以及创伤递进式(step up approach)治疗策略取代,呈现多元化微创的治疗方式。故倡导微创理念是21世纪SAP外科干预的基本原则和必然趋势。
