Prognostic factors of critical acute pancreatitis: A prospective cohort study

Shen, Dingcheng; Wang, Di; Ning, Caihong; Lin, Chia-Yen; Cao, Xiaodan; Li, Yong; Ji, Liandong; Huang, Gengwen

doi:10.1016/j.dld.2019.04.007

Cited by 9 publications

(16 citation statements)

References 40 publications

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“…This difference may be related to the long-term use of broad-spectrum antibiotics and the decline of autoimmunity in NP patients. Most studies consider fungal infection a risk factor for mortality in infected patients[7,8,10,19,23-25]. However, whether antifungal drugs should be used prophylactically in patients with suspected or confirmed extrapancreatic (and) or pancreatic infections requiring antibiotics remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Lu¹,

Cao²,

Ding³

et al. 2019

WJG

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BACKGROUNDAcute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients.AIMTo investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications.METHODSThe clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed.RESULTSIn this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin.CONCLUSIONIn this study, we identified the timing, the common species, and site of infection in patients with NP.

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Section: Discussionmentioning

confidence: 99%

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Lu¹,

Cao²,

Ding³

et al. 2019

WJG

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“…Both factors were closely associated with antimicrobial overuse, longer ICU and hospital stay, frequent use of invasive manoeuvers. Although still controversial, MDROs have been demonstrated to be associated with adverse clinical outcomes and increased mortality in patients with IPN and critical acute pancreatitis 6‐9 …”

Section: Introductionmentioning

confidence: 99%

“…Fungal infection of pancreatic necrosis has also been increasingly reported in the last decade. The incidence of intra‐abdominal fungal infection (AFI) varies from 3.5% to 46% 5‐7,10‐17 . A variety of factors, including antimicrobial overuse, total parenteral nutrition (TPN), longer hospital stays and frequent use of invasive interventions, predispose patients to AFI 10‐12,17,18 .…”

Section: Introductionmentioning

confidence: 99%

Candidemia indicates poor outcome in patients with infected pancreatic necrosis

Ning

Zhu

Qin

et al. 2021

Mycoses

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Background Intra‐abdominal fungal infection (AFI) and candidemia are common in patients with acute pancreatitis (AP), but with limited and conflicting reports on their clinical impacts. This study aims to evaluate the clinical impacts of AFI and candidemia in infected pancreatic necrosis (IPN). Methods A single‐centre, prospective cohort including 235 consecutive patients with IPN between January 2010 and September 2020 was analysed to study the clinical impacts of AFI and candidemia. Results Of the 235 patients with IPN, 69 patients (29.4%) developed AFI and 13 patients (5.5%) developed candidemia. AFI was associated with higher intestinal leakage rate (27.5% vs 12.7%, P = .006), higher pancreatic fistula rate (53.6% vs 34.3%, P = .006) and longer hospital stays (72 vs 58 days, P = .003), but with similar mortality rate compared with patients without AFI (23.2% vs 24.7%, P = .806). However, candidemia was associated with significantly higher mortality rate compared with patients without candidemia (69.2% vs 21.6%, P < .001). Patients with candidemia had higher rate of multiple organ failure and AFI (69.2% vs 36.5%, P = .018; 69.2% vs 27.0%, P = .001, respectively). Multivariable analysis showed that age ≥ 50 years (OR = 2.8; 95% CI, 1.3‐5.8; P = .007), severe category (OR = 11.2; 95% CI, 3.5‐35.7; P < .001), multidrug‐resistant organisms infection (OR = 2.5; 95% CI, 1.0‐6.2; P = .039), candidemia (OR = 11.8; 95% CI, 2.5‐56.5; P = .002), step‐down surgical approach (OR = 3.2; 95% CI, 1.5‐7.0; P = .004) were the independent predictors associated with higher mortality in IPN patients. Conclusion Although AFI did not increase the mortality of IPN, patients with candidemia carried significantly higher mortality.

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“…variables were expressed using mean ± standard deviation (SD) and median ± interquartile ranges (IQR), and categorical variables were described in absolute numbers and in percentages, in the univariate analysis, the Fisher exact test, the χ2 test, and binary logistic regression analysis were used for bivariate comparisons. Then the significant variables were included in the multivariable analysis, which were performed using logistic regression analysis as we described previously [4]. Receiver operating characteristic (ROC) curves were constructed for predictive variables, and the area under the curve (AUC) with 95 per cent confidence intervals calculated, optimal cut-off values for sensitivity, specificity for each parameter were derived from the ROC curves [5].…”

Section: Continuousmentioning

confidence: 99%

“…MSAP is characterized by local complications or transient organ failure (< 48 h), with a mortality of less than 5%. However, SAP is characterized with persistent failures of one or more organ system (respiratory, cardiovascular, or renal), and associated with significant morbidity and mortality [2][3][4]. Therefore, early identification of those who would progress to the severe category could allow the physicians to monitor more closely and put more medical resources.…”

Section: Introductionmentioning

confidence: 99%

Macrophage migration inhibitory factor is an early marker of severe acute pancreatitis based on the revised Atlanta classification

et al. 2021

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Background Various serum markers for early identification of severe acute pancreatitis (SAP) have been studied. Serum macrophage migration inhibitory factor (MIF) was reported to be correlated with severity of acute pancreatitis (AP) based on the 1992 Atlanta classification. However, MIF has never been proven to be predictive of disease severity based on the revised Atlanta classification (RAC). The potential predictive value of MIF needs to be further validated. Methods Consecutive patients with AP within 48 h after symptom onset and 10 healthy control volunteers were enrolled prospectively. Serum MIF levels were measured by enzyme-linked immunosorbent assay (ELISA). The predictive value of MIF, clinical scores and other serum markers were determined. Results Among 143 patients with AP, there were 52 (36.4%), 65 (45.5%) and 26 (18.1%) with mild, moderate and severe disease based on the RAC respectively. Compared with healthy volunteers, serum levels of MIF were significantly higher in AP patients, especially those with SAP (P < 0.001). Multivariate regression analysis indicated that increased serum MIF (cut-off 2.30 ng/ml, OR = 3.16, P = 0.008), IL-6 (cut-off 46.8 pg/ml, OR = 1.21, P = 0.043), APACHE II score (cut-off 7.5, OR = 2.57, P = 0.011) and BISAP score (cut-off 1.5, OR = 1.01, P = 0.038) were independent risk factors for predicting SAP (P < 0.05). By using the area under the receiver operating characteristic (ROC) curve (AUC), MIF (AUC 0.950) demonstrated more excellent discriminative power for predicting SAP than APACHE II (AUC 0.899), BISAP (AUC 0.886), and IL-6 (AUC 0.826). Conclusions Serum MIF is a valuable early marker for predicting the severity of AP based on the RAC.

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Prognostic factors of critical acute pancreatitis: A prospective cohort study

Cited by 9 publications

References 40 publications

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

Candidemia indicates poor outcome in patients with infected pancreatic necrosis

Macrophage migration inhibitory factor is an early marker of severe acute pancreatitis based on the revised Atlanta classification

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