Impact of continuous regional arterial infusion in the treatment of acute necrotizing pancreatitis: analysis of a national administrative database
Impact of continuous regional arterial infusion in the treatment of acute necrotizing pancreatitis: analysis of a national administrative database
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DOI：
10.1007/s00535-018-1452-4
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发表时间：
2018-09-01
影响因子：
6.3
通讯作者：
Otomo, Yasuhiro
中科院分区：
文献类型：
--
作者：
Endo, Akira;Shiraishi, Atsushi;Otomo, Yasuhiro
尽管蛋白酶抑制剂和广泛抗生素的持续区域动脉输注（CRAI）已被建议作为急性坏死性胰腺炎（ANP）患者的治疗选择之一，但其有效性尚未在临床研究中得到很好的证实。我们使用日本国家行政数据库进行了回顾性队列研究。根据是否行cri，对胰腺区强化不良（即明确或临床怀疑ANP）的重症急性胰腺炎患者进行识别和二分类。我们采用多变量混合效应回归分析和倾向评分匹配分析，比较了两组间住院死亡率、手术干预、免住院天数和医疗费用的结果，这些结果通过久经验证的病例组合调整模型进行调整。在243312例急性胰腺炎患者中，确定了702例符合条件的患者，其中339例患者接受了cri。所建立的病例组合调整模型对住院死亡率具有较好的可预测性，患者工作特征曲线下面积为0.87。cri与院内死亡率降低显著相关[cri组为14.5%，非cri组为18.2%，校正优势比（95%置信区间；CI） = 0.60(0.36-0.97)]。未观察到手术干预频率和平均无住院天数之间的显著关联；然而，在CRAI组中观察到明显更高的医疗保健费用。倾向评分匹配分析的结果没有改变这些结果。对全国性大型数据库的分析表明，CRAI与ANP患者住院死亡率的降低显著相关。进一步的随机对照试验是有必要的。
Although continuous regional arterial infusion (CRAI) of protease inhibitors and broad antibiotics has been suggested as one of the therapeutic option for patients with acute necrotic pancreatitis (ANP), the effectiveness has not been well-corroborated in clinical studies.We conducted a retrospective cohort study using a Japanese national administrative database. Severe acute pancreatitis patients with a poorly enhanced pancreas region (i.e., definitive or clinically suspected ANP) were identified and dichotomized according to whether CRAI was performed. We compared the outcomes of in-hospital mortality, surgical interventions, hospital-free days, and healthcare costs between groups adjusted by the well-validated case-mix adjustment model using a multivariate mixed-effect regression analysis and a propensity score matching analysis.Of 243,312 acute pancreatitis patients, 702 eligible patients were identified, of these 339 patients underwent CRAI. The case-mix adjustment model established had good predictability for in-hospital mortality with an area under the receiver operating characteristics curve of 0.87. CRAI was significantly associated with reduced in-hospital mortality [14.5% in the CRAI group vs. 18.2% in the non-CRAI group, adjusted odds ratio (95% confidence interval; CI) = 0.60 (0.36-0.97)]. Significant associations were not observed for the frequency of surgical interventions and mean hospital-free days; however, significantly higher healthcare costs were observed in the CRAI group. Results of the propensity score matching analysis did not alter these results.Analysis of a nationwide large-scale database suggested that CRAI was significantly associated with reduced in-hospital mortality for patients with ANP. Further randomized controlled trials are warranted.