Aim. To study the influence of systemic disorders on the risk of developing pancreatogenic encephalopathy. Materials and methods. In the period from 2010 to 2020, a prospective non-randomized cohort study was conducted at the clinical base of Department of Faculty Surgery of Volgograd State Medical University. ROC analysis was used to determine the impact of systemic disorders on the risk of developing pancreatogenic encephalopathy (PEP). The influence of the pancreatic necrosis trigger on the risk of multiple organ failure syndrome (MOF) was determined using logistic regression analysis. Results. The study included 429 patients with acute destructive pancreatitis. It was revealed that the debut of systemic disorders occurred on average on the first day of hospitalization. The most common were intestinal and cardiovascular insufficiency - 336 (78,3 %) and 242 (56,4 %) cases, respectively. In patients with alcohol-associated pancreatic necrosis (AAPN), intestinal failure was significantly more common [144 (84,7 %) versus 192 (74,1 %), OR = 1,93, CI 1,164-3,210, p = 0,012] and multiple systemic disorders [159 (93,5 %) versus 224 (86,5 %), OR = 1,18, CI 0,659-2,122, p = 0,025] than in patients with non-alcoholic pancreatic necrosis (NAPN). The conducted logistic regression analysis proved an increased risk of PEP in the presence of any organ dysfunction. However, no such relationship was found for acute renal failure. The risk of developing MODS in patients with AAPN increases by 37,5 % compared with patients with non-alcoholic pancreatic necrosis, while the specificity and sensitivity reach 75,3 % and 70,0 %, respectively. Conclusions. In patients with alcoholic genesis of pancreatic necrosis, the risk of intestinal failure, as well as multiple systemic disorders, significantly increases. A significant increase in the likelihood of organ and multiorgan disorders in patients with pancreatogenic encephalopathy was revealed.

Resume. Aim. Study of the dependence of the degree of risk of developing pancreatogenic encephalopathy (PEP) on demographic variables in patients with nutritional pancreatic necrosis. Materials and methods. A single-center prospective cohort non-randomized study was conducted on the basis of the Faculty Surgery Clinic of the Volgograd State Medical University in the period from 2010 to 2020. To determine the significance of the influence of a patient-dependent factor on the risk of developing PEP, ROC analysis was used. Logistic regression analysis was used to determine the degree of risk of developing PEP against the background of a combination of several covariates. Results. The study included 429 patients with pancreatic necrosis of alimentary origin. A comparative analysis of the incidence of PEP was carried out depending on gender and age, the trigger of the disease (alcohol-associated versus non-alcoholic pancreatic necrosis) and comorbid background. It has been proven that significant factors that increase the risk of developing PEP are age over 60 years (p = 0,04), alcohol-associated pancreatic necrosis (p < 0,001) and cardiovascular pathology - ischemic heart disease (p < 0,001). A statistically significant regression model of the effect of cardiovascular pathology on the incidence of PEP has been developed, which makes it possible to calculate the risk of this complication in a particular patient. Conclusions. Significant demographic variables that increase the risk of PEP include age over 60 years, alcoholic pancreatitis, and the presence of coronary artery disease in a patient. The developed logistic model makes it possible to calculate the personalized risk of PEP during hospitalization of a patient with nutritional pancreatic necrosis.

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ФГБОУ ВО «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации, ГБУ ВМНЦ центр хирургической гепатологии, кафедра факультетской хирургии c курсом эндоскопической хирургии ФУВ и курсом сердечно-сосудистой хирургии ФУВЦелью нашего исследования явилось улучшение результатов лечения больных с ранними системными осложне-ниями панкреонекроза.За 2006-2013 гг. было госпитализировано 418 пациентов с указанной патологией. В 219 (52,4 %) наблюдениях они обращались за медицинской помощью в первые сутки заболевания, а в 199 (47,6 %) -в более поздние сроки. Тяжесть состояния больных оценивали в динамике посредством шкалы SAPS. Дебют системных дисфункций наблюда-ли в I фазе панкреонекроза у 411 (98,3 %) пациентов, а на более поздних стадиях -у 7 (1,7 %) больных. Наиболее распро-страненным системным осложнением панкреонекроза была печеночная недостаточность -64,4 %. Наиболее выражен-ное влияние на исход основного заболевания оказывали респираторные (ОШ летального исхода -87,230) и кардиовас-кулярные расстройства (ОШ смерти -63,011). Наиболее частым (45 %) и тяжелым вариантом течения системных нарушений стала полиорганная недостаточность.Ключевые слова: системные осложнения панкреонекроза, моноорганная дисфункция, полиорганная дисфункция, полиорганная недостаточность. FEATURES OF EARLY SYSTEMIC COMPLICATIONS IN PATIENTS WITH DESTRUCTIVE PANCREATITIS A. G. Beburishvili, N. Sh. Burchuladze, A. S. Mazunov Volgograd State Medical University, Department of Faculty Surgery with the Course of Endoscopy and the Course of Cardiovascular Surgery, Department of Continuing Education, Volgograd Medical Research Center of Surgical HepatologyThe aim of the research was to improve the treatment results of early systemic complications in pancreonecrotic patients.In the period of [2006][2007][2008][2009][2010][2011][2012][2013] 418 patients with this pathology were hospitalized. In 219 (52,4 %) cases they sought medical help on the 1 st day after the disease onset, and in 199 (47,6 %) -at a later date. The severity of the patients was progressively evaluated by SAPS scale. The onset of systemic complications was observed in the first phase of pancreonecrosis in 411 (98.3%) cases, and at later stages -in 7 (1.7%) patients. The most common systemic complication of pancreonecrosis was hepatic insufficiency -64,4 %. Respiratory (odds ratio of death -87,230) and cardiovascular disorders (odds ratio of death -63,011) contributed most significantly to the outcome of the underlying disease. The most frequent (45%) and severe systemic impairment was multiorgan failure.Key words: early systemic complications of pancreonecrosis, monoorganic dysfunction, polyorganic dysfunction, multisystem organ failure.Заболеваемость деструктивным панкреатитом, не-смотря на многолетнюю историю изучения проблемы и про-грессивное развитие медицины, продолжает расти во всем мире. Летальность среди больных панкреонекрозом оста-ется очень высокой, достигая 20-53 % [1-3, 5, 6]. При этом на первую фазу заболевания приходится о...

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