Early infection is an independent risk factor for increased mortality in patients with culture-confirmed infected pancreatic necrosis.
Infected pancreatic necrosis
Minimally invasive surgery
Mortality
Necrosectomy
Necrotizing pancreatitis
Pancreatic necrosis
Surgery
Journal
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
ISSN: 1424-3911
Titre abrégé: Pancreatology
Pays: Switzerland
ID NLM: 100966936
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
23
04
2021
revised:
01
11
2021
accepted:
03
11
2021
pubmed:
15
11
2021
medline:
29
3
2022
entrez:
14
11
2021
Statut:
ppublish
Résumé
Mortality in infected pancreatic necrosis (IPN) is dynamic over the course of the disease, with type and timing of interventions as well as persistent organ failure being key determinants. The timing of infection onset and how it pertains to mortality is not well defined. To determine the association between mortality and the development of early IPN. International multicenter retrospective cohort study of patients with IPN, confirmed by a positive microbial culture from (peri) pancreatic collections. The association between timing of infection onset, timing of interventions and mortality were assessed using Cox regression analyses. A total of 743 patients from 19 centers across 3 continents with culture-confirmed IPN from 2000 to 2016 were evaluated, mortality rate was 20.9% (155/734). Early infection was associated with a higher mortality, when early infection occurred within the first 4 weeks from presentation with acute pancreatitis. After adjusting for comorbidity, advanced age, organ failure, enteral nutrition and parenteral nutrition, early infection (≤4 weeks) and early open surgery (≤4 weeks) were associated with increased mortality [HR: 2.45 (95% CI: 1.63-3.67), p < 0.001 and HR: 4.88 (95% CI: 1.70-13.98), p = 0.003, respectively]. There was no association between late open surgery, early or late minimally invasive surgery, early or late percutaneous drainage with mortality (p > 0.05). Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Mortality in infected pancreatic necrosis (IPN) is dynamic over the course of the disease, with type and timing of interventions as well as persistent organ failure being key determinants. The timing of infection onset and how it pertains to mortality is not well defined.
OBJECTIVES
OBJECTIVE
To determine the association between mortality and the development of early IPN.
METHODS
METHODS
International multicenter retrospective cohort study of patients with IPN, confirmed by a positive microbial culture from (peri) pancreatic collections. The association between timing of infection onset, timing of interventions and mortality were assessed using Cox regression analyses.
RESULTS
RESULTS
A total of 743 patients from 19 centers across 3 continents with culture-confirmed IPN from 2000 to 2016 were evaluated, mortality rate was 20.9% (155/734). Early infection was associated with a higher mortality, when early infection occurred within the first 4 weeks from presentation with acute pancreatitis. After adjusting for comorbidity, advanced age, organ failure, enteral nutrition and parenteral nutrition, early infection (≤4 weeks) and early open surgery (≤4 weeks) were associated with increased mortality [HR: 2.45 (95% CI: 1.63-3.67), p < 0.001 and HR: 4.88 (95% CI: 1.70-13.98), p = 0.003, respectively]. There was no association between late open surgery, early or late minimally invasive surgery, early or late percutaneous drainage with mortality (p > 0.05).
CONCLUSION
CONCLUSIONS
Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.
Identifiants
pubmed: 34774414
pii: S1424-3903(21)00614-1
doi: 10.1016/j.pan.2021.11.003
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
67-73Informations de copyright
Copyright © 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Mouen Khashab is a consultant for Boston Scientific, Olympus and Medtronic. Robert A. Moran is a consultant for Cook medical. Vikesh K Singh is a consultant to Abbvie and Theraly, advisory board participant for Cook Medical, and receives grant funding from Orgenesis. Tyler Stevens is a consultant for Boston Scientific. All other authors have no conflicts of interest to disclose.