Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
Articolo
Data di Pubblicazione:
2023
Abstract:
The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990).
Tipologia CRIS:
14.a.1 Articolo su rivista
Keywords:
Acute pancreatitis, Infected pancreatic necrosis, International study, Mortality, Organ failure
Elenco autori:
Podda, Mauro; Pellino, Gianluca; Di Saverio, Salomone; Coccolini, Federico; Pacella, Daniela; Cioffi, Stefano Piero Bernardo; Virdis, Francesco; Balla, Andrea; Ielpo, Benedetto; Pata, Francesco; Poillucci, Gaetano; Ortenzi, Monica; Damaskos, Dimitrios; De Simone, Belinda; Sartelli, Massimo; Leppaniemi, Ari; Jayant, Kumar; Catena, Fausto; Giuliani, Antonio; Di Martino, Marcello; Pisanu, Adolfo; Gerardi, Chiara; Gourgiotis, Stavros; Riboni, Cristiana; Giordano, Alessio; Ferrario, Luca; Agnoletti, Vanni; Kruger, Yoram; Mole, Damian; Agresta, Ferdinando; Prieto Calvo, Mikel; Wilson, Michael; Soggiu, Fiammetta; Hamdan, Alaa; Gomes, Carlos Augusto; Fraga, Gustavo; Ioannidis, Argyrios; Demetrashvili, Zaza; Sahani, Saaz; Bains, Lovenish; Khamees, Almu’Atasim; Ababneh, Hazim; Aljaiuossi, Osama; Pimentel, Samuel; Mohamad, Ikhwan Sani; Yusoff, Ahmad Ramzi; Zarnescu, Narcis Octavian; Calu, Valentin; Litvin, Andrey; Lesko, Dusan; Elmehrath, Ahmed; Elshami, Mohamedraed; de Santibañes, Martin; Gundara, Justin; Alawadhi, Kamel; Lui, Rashid; Julianov, Alexander; Ralon, Sergio; Garzali, Ibrahim-Umar; Machain, Gustavo M; Villalabeitia, Ibabe; Quispe-Cruz, Darwin Artidoro; Orantia, Abigail Cheska C.; Walędziak, Maciej; de Sá, Tiago Correia; Ali, Syed Muhammad; Kovacevic, Bojan; Noel, Colin; Abdalah, Haidar M.; Kchaou, Ali; Isik, Arda; Ansaloni, Luca; Biffl, Walter; Guerrieri, Mario; Sartori, Alberto; Abradelo, Manuel; Nigri, Giuseppe; Di Lorenzo, Nicola; Mingoli, Andrea; Chiarugi, Massimo; Di Menno Stavron, Juliana; Mazza, Oscar; Valenzuela, José Ignacio; Pachajoa, Diana Alejandra Pantoja; Alvarez, Fernando Andrés; Liaño, Julian Ezequiel; Tefay, Joan; Alshaikh, Abdulrahman; Hasan, Layla; Couto Gomes, Felipe; Calderan, Thiago R. A.; Hirano, Elcio S.; Dardanov, Dragomir; Saroglu, Azize; Atanasov, Boyko; Belev, Nikolay; Kovachev, Nikola; Chan, Shannon Melissa; Lok, Hon-Ting; Salcedo, Diego; Robayo, Diana; Triviño, María Alejandra; Manak, Jan; de Araujo, Jorann; Sethi, Ananya; Awad, Ahmed; Elbadawy, Merihan; Farid, Ahmed; Hanafy, Asmaa; Nafea, Ahmed; Sherief, Ghozy; Salah Alzhraa, Abbas; Abdelsalam, Wafaa; Emile, Sameh; Elfallal, Ahmed; Elfeki, Hossam; Elghadban, Hosam; Shoma, Ashraf; Shetiwy, Mohamed; Elbahnasawy, Mohamed; Mohamed, Salem; Hamed, Emad Fawzi; Khalil, Usama Ahmed; Chouillard, Elie; Gumbs, Andrew; Police, Andrea; Mabilia, Andrea; Khutsishvili, Kakhi; Tvaladze, Anano; Ioannidis, Orestis; Anestiadou, Elissavet; Loutzidou, Lydia; Konstantinidis, Konstantinis; Konstantinidou, Sofia; Manatakis, Dimitrios; Acheimastos, Vasileios; Tasis, Nikolaos; Michalopoulos, Nikolaos; Kokoropoulos, Panagiotis; Papadoliopoulou, Maria; Sotiropoulou, Maria; Kapiris, Stylianos; Metaxas, Panagiotis; Tsouknidas, Ioannis; Kefili, Despoina; Petrakis, George; Synekidou, Eirini; Dakis, Konstantinos; Alexandridou, Eirini; Papadopoulos, Aristeidis; Chouliaras, Christos; Mouzakis, Odysseas; Mulita, Francesk; Maroulis, Ioannis; Vailas, Michail; Triantafyllou, Tania; Theodorou, Dimitrios; Lostoridis, Eftychios; Nagorni, Eleni-Aikaterini; Tourountzi, Paraskevi; Baili, Efstratia; Charalabopoulos, Alexandros; Liakakos, Theodore; Schizas, Dimitrios; Kozadinos, Alexandros; Syllaios, Athanasios; Machairas, Nikolaos; Kykalos, Stylianos; Stamopoulos, Paraskevas; Delis, Spiros; Farazi-Chongouki, Christos; Kalaitzakis, Evangelos; Giannarakis, Miltiadis; Lasithiotakis, Konstantinos; Petra, Giorgia; Gupta, Amit; Medappil, Noushif; Muthukrishnan, Vijayanand; Kamar, Jubin; Lal, Pawan; Agarwal, Rajendra; Magnoli, Matteo; Aonzo, Paolo; Serventi, Alberto; Di Lascio, Pierpaolo; Pinto, Margherita; Bergamini, Carlo; Bottari, Andrea; Fortuna, Laura; Martellucci, Jacopo; Cicako, Atea; Miglietta, Claudio; Morino, Mario; Delogu, Daniele; Picchetto, Andrea; Assenza, Marco; D’Ambrosio, Giancarlo; Argenio, Giulio; Armellino, Mariano Fortunato; Ioia, Giovanna; Occhionorelli, Savino; Andreotti, Dario; Domenico, Lacavalla; Luppi, Davide; Casadei, Mass
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