Relationship of Somatic Systemic Disturbances, the Trigger of Pancreatic Necrosisand Pancreatogenic Encephalopathy

Abstract

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.