中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 3
Mar.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(3): 654-659

Association of the duration of systemic inflammatory response syndrome with infectious pancreatic necrosis at the initial stage of acute pancreatitis

DOI: 10.3969/j.issn.1001-5256.2021.03.029

  • Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

  • Received Date: 2020-08-27
  • Accepted Date: 2020-10-20
  • Published Date: 2021-03-20
    Abstract
  •   Objective  To investigate the potential association between early-stage inflammatory response and late-stage infectious pancreatic necrosis (IPN) in patients with acute pancreatitis (AP).  Methods  A retrospective analysis was performed for the clinical data of 219 patients with moderate-severe acute pancreatitis (MSAP) and 53 patients with severe acute pancreatitis (SAP) who were admitted to The Affiliated Hospital of Southwest Medical University from June 2019 to June 2020, and according to the presence or absence of systemic inflammatory response syndrome (SIRS) at the initial stage of the disease, they were divided into SIRS group with 160 patients and non-SRIS group with 112 patients. Baseline data, serological markers, complications, and mortality rate were included for analysis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between multiple groups, and the Bonferroni method was used for further comparison between two groups. A logistic regression analysis was used to screen out valuable variables; the receiver operating characteristic (ROC) curve was used to compare the diagnostic value of variables, and the Z-test was used for pairwise comparison of area under the ROC curve (AUC).  Results  Compared with the non-SIRS group, the SIRS group had significantly higher white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (all P < 0.05) and a significantly higher proportion of patients with acute peripancreatic necrosis (ANC), IPN, pancreatic necrosis (PN), organ dysfunction, multiple organ dysfunction syndrome (MODS), SAP, critically-ill acute pancreatitis (CAP), death, BISAP score > 2, CTSI score > 2, or RANSON score > 2 (all P < 0.05). The univariate analysis showed that SIRS duration, obesity, CRP, WBC, blood urea nitrogen, PN, ANC, SAP, MODS, RANSON score, BISAP score, and CTSI score were risk factors for IPN in patients with AP (all P < 0.05), and the multivariate analysis showed that SIRS duration (odds ratio [OR]=1.307, 95% confidence interval [CI]: 1.081-1.580, P=0.006) and ANC (OR=42.247, 95% CI: 10.829-164.818, P < 0.001) were risk factors for IPN; when ANC was excluded, SIRS duration (OR=1.430, 95% CI: 1.207-1.694, P < 0.001) and PN (OR=5.296, 95% CI: 1.845-15.203, P=0.002) were risk factors for IPN. The ROC curve showed that SIRS duration (AUC=0.772, Youden index=0.521), RANSON score (AUC=0.701, Youden index=0.319), BISAP score (AUC=0.741, Youden index=0.377), and CTSI score (AUC=0.765, Youden Index=0.414) had a certain value in predicting IPN, and there was no significant difference in AUC between any two indices. The long-duration SIRS group (> 4 d) had a significantly higher proportion of patients with PN, ANC, IPN, SAP, or CAP than the non-SIRS group (0 d), the transient SIRS group (1~2 d), and the persistent SIRS group (3~4 d) (all P < 0.05), and the persistent SIRS group had a significantly higher proportion of patients with SAP than the non-SIRS group (P < 0.05).  Conclusion  AP patients with SIRS in the early stage are likely to develop organ failure and local complications, and there is a significant increase in the risk of IPN when SIRS duration is > 4.5 days.

     

    • FullText(HTML)
  • loading
    • References(31)
  • [1]
    Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shenyang, 2019)[J]. J Clin Hepatol, 2019, 35(12): 2706-2711. (in Chinese)

    中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编委会, 《中华消化杂志》编委会. 中国急性胰腺炎诊治指南(2019年, 沈阳)[J]. 临床肝胆病杂志, 2019, 35(12): 2706-2711.
    [2]
    LEPPÄNIEMI A, TOLONEN M, TARASCONI A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis[J]. World J Emerg Surg, 2019, 14: 27. DOI: 10.1186/s13017-019-0247-0
    [3]
    TAN C, YANG L, SHI F, et al. Early systemic inflammatory response syndrome duration predicts infected pancreatic necrosis[J]. J Gastrointest Surg, 2020, 24(3): 590-597. DOI: 10.1007/s11605-019-04149-5
    [4]
    SILVA-VAZ P, ABRANTES AM, MORGADO-NUNES S, et al. Evaluation of prognostic factors of severity in acute biliary pancreatitis[J]. Int J Mol Sci, 2020, 21(12) : 4300. DOI: 10.3390/ijms21124300
    [5]
    VENKATESH NR, VIJAYAKUMAR C, BALASUBRAMANIYAN G, et al. Comparison of different scoring systems in predicting the severity of acute pancreatitis: A prospective observational study[J]. Cureus, 2020, 12(2): e6943. http://www.researchgate.net/publication/339176836_Comparison_of_Different_Scoring_Systems_in_Predicting_the_Severity_of_Acute_Pancreatitis_A_Prospective_Observational_Study
    [6]
    SOULOUNTSI V, SCHIZODIMOS T. Use of antibiotics in acute pancreatitis: Ten major concerns[J]. Scand J Gastroenterol, 2020, 55(10): 1211-1218. DOI: 10.1080/00365521.2020.1804995
    [7]
    CASE BM, JENSEN KK, BAKIS G, et al. Endoscopic interventions in acute pancreatitis: What the advanced endoscopist wants to know[J]. Radiographics, 2018, 38(7): 2002-2018. DOI: 10.1148/rg.2018180066
    [8]
    ARVANITAKIS M, DUMONCEAU JM, ALBERT J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines[J]. Endoscopy, 2018, 50(5): 524-546. DOI: 10.1055/a-0588-5365
    [9]
    TRIKUDANATHAN G, WOLBRINK D, van SANTVOORT HC, et al. Current concepts in severe acute and necrotizing pancreatitis: An evidence-based approach[J]. Gastroenterology, 2019, 156(7): 1994-2007. DOI: 10.1053/j.gastro.2019.01.269
    [10]
    SHARMA D, JAKKAMPUDI A, REDDY R, et al. Association of systemic inflammatory and anti-inflammatory responses with adverse outcomes in acute pancreatitis: Preliminary results of an ongoing study[J]. Dig Dis Sci, 2017, 62(12): 3468-3478. DOI: 10.1007/s10620-017-4813-6
    [11]
    SENDLER M, van den BRANDT C, GLAUBITZ J, et al. NLRP3 inflammasome regulates development of systemic inflammatory response and compensatory anti-inflammatory response syndromes in mice with acute pancreatitis[J]. Gastroenterology, 2020, 158(1): 253-269. DOI: 10.1053/j.gastro.2019.09.040
    [12]
    YANG R, TENHUNEN J, TONNESSEN TI. HMGB1 and histones play a significant role in inducing systemic inflammation and multiple organ dysfunctions in severe acute pancreatitis[J]. Int J Inflam, 2017, 2017: 1817564. http://www.ncbi.nlm.nih.gov/pubmed/28316860
    [13]
    CHEN Z, DONG WH, WU Q, et al. Two-layer regulation of TRAF6 mediated by both TLR4/NF-kB signaling and miR-589-5p increases proinflammatory cytokines in the pathology of severe acute pancreatitis[J]. Am J Transl Res, 2020, 12(6): 2379-2395. http://www.zhangqiaokeyan.com/academic-journal-foreign-pmc_american-journal-translational-research_thesis/040006415721.html
    [14]
    IYER S, BAWA EP, TARIQUE M, et al. Know thy enemy-understanding the role of inflammation in severe acute pancreatitis[J]. Gastroenterology, 2020, 158(1): 46-48. DOI: 10.1053/j.gastro.2019.11.039
    [15]
    DIXIT A, CHEEMA H, GEORGE J, et al. Extracellular release of ATP promotes systemic inflammation during acute pancreatitis[J]. Am J Physiol Gastrointest Liver Physiol, 2019, 317(4): g463-g475. DOI: 10.1152/ajpgi.00395.2018
    [16]
    DUMNICKA P, MADUZIA D, CERANOWICZ P, et al. The interplay between inflflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: Clinical implications[J]. Int J Mol Sci, 2017, 18(2): 354. DOI: 10.3390/ijms18020354
    [17]
    GAD MM, SIMONS-LINARES CR. Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies[J]. World J Gastroenterol, 2020, 26(10): 1098-1106. DOI: 10.3748/wjg.v26.i10.1098
    [18]
    YE B, MAO W, CHEN Y, et al. Aggressive resuscitation is associated with the development of acute kidney injury in acute pancreatitis[J]. Dig Dis Sci, 2019, 64(2): 544-552. DOI: 10.1007/s10620-018-5328-5
    [19]
    CHOOSAKUL S, HARINWAN K, CHIRAPONGSATHORN S, et al. Comparison of normal saline versus Lactated Ringer's solution for fluid resuscitation in patients with mild acute pancreatitis, A randomized controlled trial[J]. Pancreatology, 2018, 18(5): 507-512. DOI: 10.1016/j.pan.2018.04.016
    [20]
    FROGHI F, SOGGIU F, RICCIARDI F, et al. Ward-based goal-directed fluid therapy (GDFT) in acute pancreatitis (GAP) trial: Study protocol for a feasibility randomised controlled trial[J]. BMJ Open, 2019, 9(10): e028783. DOI: 10.1136/bmjopen-2018-028783
    [21]
    WOLBRINK D, GRUNDSELL JR, WITTEMAN B, et al. Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis[J]. Clin Nutr, 2020, 39(9): 2686-2694. DOI: 10.1016/j.clnu.2019.12.006
    [22]
    RUIZ-REBOLLO ML, MUÑOZ-MORENO MF, MAYO-ISCAR A, et al. Statin intake can decrease acute pancreatitis severit[J]. Pancreatology, 2019, 19(6): 807-812. DOI: 10.1016/j.pan.2019.07.004
    [23]
    JIANG X, SHI JY, WANG XY, et al. The impacts of infectious complications on outcomes in acute pancreatitis: A retrospective study[J]. Mil Med Res, 2020, 7(1): 38. http://www.researchgate.net/publication/343685598_The_impacts_of_infectious_complications_on_outcomes_in_acute_pancreatitis_a_retrospective_study
    [24]
    TIAN H, CHEN L, WU X, et al. Infectious complications in severe acute pancreatitis: Pathogens, drug resistance, and status of nosocomial infection in a university-affiliated teaching hospital[J]. Dig Dis Sci, 2020, 65(7): 2079-2088. DOI: 10.1007/s10620-019-05924-9
    [25]
    BARON TH, DIMAIO CJ, WANG AY, et al. American Gastroenterological association clinical practice update: Management of pancreatic necrosis[J]. Gastroenterology, 2020, 158(1): 67-75. DOI: 10.1053/j.gastro.2019.07.064
    [26]
    SUSAK YM, DIRDA OO, FEDORCHUK OG, et al. Infectious complications of acute pancreatitis is associated with peripheral blood phagocyte functional exhaustion[J]. Dig Dis Sci, 2020.[Online ahead of print]
    [27]
    LU JD, CAO F, DING YX, et al. Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis[J]. World J Gastroenterol, 2019, 25(34): 5162-5173. DOI: 10.3748/wjg.v25.i34.5162
    [28]
    AUSANIA F, SENRA DEL RÍO P, BORIN A, et al. Factors associated with mortality in patients with infected pancreatic necrosis: The "surgery effect"[J]. Updates Surg, 2020, 72(4): 1097-1103. DOI: 10.1007/s13304-020-00764-z
    [29]
    ZHANG ZH, DING YX, WU YD, et al. A meta-analysis and systematic review of percutaneous catheter drainage in treating infected pancreatitis necrosis[J]. Medicine (Baltimore), 2018, 97(47): e12999. DOI: 10.1097/MD.0000000000012999
    [30]
    DARRIVERE L, LAPIDUS N, COLIGNON N, et al. Minimally invasive drainage in critically ill patients with severe necrotizing pancreatitis is associated with better outcomes: An observational study[J]. Crit Care, 2018, 22(1): 321. DOI: 10.1186/s13054-018-2256-x
    [31]
    SUN B, LI GQ. Surgical intervention strategies for local complications of severe acute pancreatitis[J]. Chin J Dig Surg, 2020, 19(4): 379-383. (in Chinese)
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(6)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (623) PDF downloads(59) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return