Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis
Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis
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DOI：
10.1136/gutjnl-2017-314657
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发表时间：
2019-06-01
期刊：
影响因子：
24.5
通讯作者：
Bruno, Marco J.
中科院分区：
文献类型：
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作者：
Schepers, Nicolien J.;Bakker, Olaf J.;Bruno, Marco J.
目的在胰腺炎患者中，早期持续器官衰竭被认为是最重要的死亡原因。本研究探讨了坏死性胰腺炎患者器官衰竭的时间（发病和持续时间）与死亡率之间的关系及其与感染性胰腺坏死的关系。我们对来自21家医院的639例坏死性胰腺炎患者的前瞻性数据库进行了事后分析。我们评估了器官衰竭的发病、持续时间和类型（如呼吸衰竭、心血管衰竭和肾衰竭）及其与死亡率和感染性胰腺坏死的关系。结果639例坏死性胰腺炎患者中有240例（38%）发生器官衰竭。51%的患者在第一周出现持续性器官衰竭（即任何类型或组合），死亡率为42%；13%的患者在第二周出现持续性器官衰竭，死亡率为46%；36%的患者在第二周后出现持续性器官衰竭，死亡率为29%。持续时间< 1周、1-2周、2-3周或大于3周的患者死亡率分别为43%、38%、46%和52% （p= 0.68）。单纯器官衰竭患者的死亡率高于器官衰竭合并感染性胰腺坏死患者（44% vs 29%, p= 0.04）。然而，当排除极早死亡（入院10天内）的患者时，伴有或不伴有感染性胰腺坏死的器官衰竭患者的死亡率相似（28% vs 34%, p= 0.33）。结论在坏死性胰腺炎患者中，早期持续性器官衰竭与病程中进一步发展的持续性器官衰竭相比，与死亡率增加无关。此外，没有发现器官衰竭持续时间与死亡率之间的关联。
Objective I n patients with pancreatitis, early persisting organ failure is believed to be the most important cause of mortality. This study investigates the relation between the timing (onset and duration) of organ failure and mortality and its association with infected pancreatic necrosis in patients with necrotising pancreatitis. Design We performed a post hoc analysis of a prospective database of 639 patients with necrotising pancreatitis from 21 hospitals. We evaluated the onset, duration and type of organ failure (ie, respiratory, cardiovascular and renal failure) and its association with mortality and infected pancreatic necrosis. Results I n total, 240 of 639 (38%) patients with necrotising pancreatitis developed organ failure. Persistent organ failure (ie, any type or combination) started in the first week in 51% of patients with 42% mortality, in 13% during the second week with 46% mortality and in 36% after the second week with 29% mortality. Mortality in patients with persistent multiple organ failure lasting < 1 week, 1-2 weeks, 2-3 weeks or longer than 3 weeks was 43%, 38%, 46% and 52%, respectively (p= 0.68). Mortality was higher in patients with organ failure alone than in patients with organ failure and infected pancreatic necrosis (44% vs 29%, p= 0.04). However, when excluding patients with very early mortality (within 10 days of admission), patients with organ failure with or without infected pancreatic necrosis had similar mortality rates (28% vs 34%, p= 0.33). Conclusion I n patients with necrotising pancreatitis, early persistent organ failure is not associated with increased mortality when compared with persistent organ failure which develops further on during the disease course. Furthermore, no association was found between the duration of organ failure and mortality.