中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

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
  • Received Date: 2020-08-27
  • Accepted Date: 2020-10-20
  • Published Date: 2021-03-20
  •   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.

     

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    Created with Highcharts 5.0.7Chart context menuAccess Area Distribution其他: 8.0 %其他: 8.0 %其他: 2.3 %其他: 2.3 %Bengaluru: 0.2 %Bengaluru: 0.2 %China: 0.1 %China: 0.1 %Elizabeth City: 0.2 %Elizabeth City: 0.2 %Germany: 0.2 %Germany: 0.2 %Greece: 0.1 %Greece: 0.1 %India: 0.8 %India: 0.8 %Mexico: 0.3 %Mexico: 0.3 %San Lorenzo: 0.1 %San Lorenzo: 0.1 %Taiwan, China: 0.2 %Taiwan, China: 0.2 %United States: 0.5 %United States: 0.5 %[]: 0.8 %[]: 0.8 %上海: 2.4 %上海: 2.4 %东莞: 0.2 %东莞: 0.2 %丽水: 0.1 %丽水: 0.1 %佛山: 0.1 %佛山: 0.1 %保定: 0.4 %保定: 0.4 %六安: 0.2 %六安: 0.2 %兰州: 0.1 %兰州: 0.1 %北京: 3.7 %北京: 3.7 %南京: 0.8 %南京: 0.8 %南充: 0.1 %南充: 0.1 %南宁: 0.2 %南宁: 0.2 %南昌: 0.1 %南昌: 0.1 %台州: 0.2 %台州: 0.2 %合肥: 0.2 %合肥: 0.2 %吉林: 1.6 %吉林: 1.6 %哥伦布: 0.1 %哥伦布: 0.1 %天津: 0.3 %天津: 0.3 %奥里萨: 0.3 %奥里萨: 0.3 %娄底: 0.1 %娄底: 0.1 %宁波: 0.3 %宁波: 0.3 %安顺: 0.1 %安顺: 0.1 %常德: 0.1 %常德: 0.1 %广州: 0.5 %广州: 0.5 %库比蒂诺: 0.3 %库比蒂诺: 0.3 %弗吉: 0.1 %弗吉: 0.1 %张家口: 2.0 %张家口: 2.0 %德阳: 0.2 %德阳: 0.2 %成都: 0.9 %成都: 0.9 %拉贾斯坦邦: 0.3 %拉贾斯坦邦: 0.3 %旁遮普: 0.8 %旁遮普: 0.8 %昆明: 0.5 %昆明: 0.5 %晋城: 0.1 %晋城: 0.1 %杭州: 0.6 %杭州: 0.6 %武汉: 0.5 %武汉: 0.5 %永州: 0.1 %永州: 0.1 %泸州: 0.2 %泸州: 0.2 %济南: 0.3 %济南: 0.3 %深圳: 0.3 %深圳: 0.3 %湘潭: 0.1 %湘潭: 0.1 %漯河: 0.2 %漯河: 0.2 %石家庄: 0.1 %石家庄: 0.1 %福州: 0.6 %福州: 0.6 %秦皇岛: 0.1 %秦皇岛: 0.1 %芒廷维尤: 37.8 %芒廷维尤: 37.8 %芝加哥: 0.4 %芝加哥: 0.4 %苏州: 0.1 %苏州: 0.1 %荆门: 0.1 %荆门: 0.1 %莫斯科: 3.3 %莫斯科: 3.3 %萨默维尔: 0.1 %萨默维尔: 0.1 %衢州: 0.4 %衢州: 0.4 %西宁: 12.4 %西宁: 12.4 %西安: 0.2 %西安: 0.2 %贵港: 0.2 %贵港: 0.2 %贵阳: 0.3 %贵阳: 0.3 %赤峰: 0.2 %赤峰: 0.2 %运城: 1.5 %运城: 1.5 %郑州: 0.1 %郑州: 0.1 %重庆: 0.2 %重庆: 0.2 %金华: 0.1 %金华: 0.1 %长春: 4.9 %长春: 4.9 %长沙: 0.6 %长沙: 0.6 %长治: 0.1 %长治: 0.1 %雅安: 0.2 %雅安: 0.2 %青岛: 0.1 %青岛: 0.1 %首尔特别: 1.1 %首尔特别: 1.1 %马鞍山: 0.1 %马鞍山: 0.1 %驻马店: 0.1 %驻马店: 0.1 %高雄: 0.2 %高雄: 0.2 %黄冈: 0.1 %黄冈: 0.1 %其他其他BengaluruChinaElizabeth CityGermanyGreeceIndiaMexicoSan LorenzoTaiwan, ChinaUnited States[]上海东莞丽水佛山保定六安兰州北京南京南充南宁南昌台州合肥吉林哥伦布天津奥里萨娄底宁波安顺常德广州库比蒂诺弗吉张家口德阳成都拉贾斯坦邦旁遮普昆明晋城杭州武汉永州泸州济南深圳湘潭漯河石家庄福州秦皇岛芒廷维尤芝加哥苏州荆门莫斯科萨默维尔衢州西宁西安贵港贵阳赤峰运城郑州重庆金华长春长沙长治雅安青岛首尔特别马鞍山驻马店高雄黄冈

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