Early infection is an independent risk factor for increased mortality in patients with culture-confirmed infected pancreatic necrosis.

Autor: Moran RA; Department of Gastroenterology, Medical University of South Carolina, Charleston, SC, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: moranr@musc.edu., Halloran C; University of Liverpool, Liverpool, United Kingdom., Guo Q; Department of Vascular Surgery, West China Hospital Chengdu, Chengdu, China., Umapathy C; University of Pittsburgh Medical Center, Pittsburgh, PA, United States., Jalaly NY; Johns Hopkins University School of Medicine, Baltimore, MD, United States., Jain S; All Indian Institute of Medical Sciences, New Delhi, India., Cowzer D; Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Cuadrado Robles EP; Morales Meseguer Hospital, Murcia, Spain., Quesada-Vázquez N; Hospital Universitario Virgen Del Rocio, Seville, Spain., Szentesi A; First Department of Medicine, University of Szeged, Szeged, Hungary; Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary., Papp M; Institute of Medicine, Department of Gastroenterology, University of Debrecen, Debrecen, Hungary., Chua T; Cleveland Clinic, Cleveland, OH, United States., Márta K; Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary., Sampath K; Weill Cornell Medical College, New York City, NY, United States., Jin DX; Brigham and Women's Hospital, Boston, MA, United States., Sahebally SM; Department of Surgery, St Vincents University Hospital, Dublin, Ireland., Kuschnereit TP; University of Greifswald, Greifswald, Germany., Khashab MA; Johns Hopkins University School of Medicine, Baltimore, MD, United States., Rock C; Johns Hopkins University School of Medicine, Baltimore, MD, United States., Darvasi E; First Department of Medicine, University of Szeged, Szeged, Hungary., Saunders R; University of Liverpool, Liverpool, United Kingdom., García-Rayado G; Hospital General Universitario de Alicante, Alicante, Spain., Torrijos YS; Hospital Universitario Virgen Del Rocio, Seville, Spain., Coady L; Department of Surgery, St Vincents University Hospital, Dublin, Ireland., Papachristou GI; University of Pittsburgh Medical Center, Pittsburgh, PA, United States., Mayerle J; Ludwig-Maximilians-University of Munich, Munich, Germany., Geoghegan J; Department of Surgery, St Vincents University Hospital, Dublin, Ireland., Banks PA; Brigham and Women's Hospital, Boston, MA, United States., Gardner TB; Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States., Szabó AN; Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary., Stevens T; Cleveland Clinic, Cleveland, OH, United States., Tornai T; Institute of Medicine, Department of Gastroenterology, University of Debrecen, Debrecen, Hungary., Tóth E; First Department of Medicine, University of Szeged, Szeged, Hungary., McEntee G; Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Enrique de-Madaria; Hospital General Universitario de Alicante, Alicante, Spain., Garg PK; All Indian Institute of Medical Sciences, New Delhi, India., Hegyi P; MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary., Yadav D; University of Pittsburgh Medical Center, Pittsburgh, PA, United States., Hu W; Department of Pancreatic Surgery, West China Hospital, Chengdu, China., Neoptolemos J; Department of Surgery, University of Heidelberg, Heidelberg, Germany., Singh VK; Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: vsingh1@jhmi.edu.
Jazyk: angličtina
Zdroj: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] [Pancreatology] 2022 Jan; Vol. 22 (1), pp. 67-73. Date of Electronic Publication: 2021 Nov 09.
DOI: 10.1016/j.pan.2021.11.003
Abstrakt: 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: To determine the association between mortality and the development of early IPN.
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: 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: Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.
Competing Interests: 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.
(Copyright © 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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