Organ Failure and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute Pancreatitis
Organ Failure and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute Pancreatitis
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DOI：
10.1053/j.gastro.2010.06.010
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发表时间：
2010-09-01
期刊：
影响因子：
29.4
通讯作者：
Windsor, John A.
中科院分区：
文献类型：
--
作者：
Petrov, Maxim S.;Shanbhag, Satyanarayan;Windsor, John A.
背景与目的：关于器官衰竭（OF）或感染性胰腺坏死（IPN）是否是急性胰腺炎严重程度的主要决定因素，文献中的个体研究之间没有一致性。我们的目的是统计汇总现有的数据，并确定合并的影响OF和IPN对急性胰腺炎患者的死亡率。方法：在MEDLINE、EMBASE和Scopus电子数据库以及主要胃肠病学会议记录中检索相关观察性研究。汇总估计值表示为相对风险（RR）和95%置信区间（CI）。结果：对14项研究（包括1478例急性胰腺炎患者）进行荟萃分析。共有600例患者发生了OF，其中179例死亡（死亡率，30%）; 314例患者发生了IPN，其中102例死亡（死亡率，32%）。在分层分析中，与有OF且无IPN的患者相比（RR = 1.94; 95% CI：1.32-2.85; P = 0.0007），与有IPN且无OF的患者相比（RR = 2.65; 95% CI：1.30-5.40; P = 0.0007），有OF且有IPN的患者的死亡风险显著更高。结论：在急性胰腺炎患者中，OF和IPN对死亡率的绝对影响是相当的，因此任何一个的存在都表明病情严重。当OF和IPN同时存在时，死亡率的相对风险增加一倍，并表明极严重的疾病或重症急性胰腺炎。
BACKGROUND & AIMS: There is no consistency between the individual studies in the literature on whether organ failure (OF) or infected pancreatic necrosis (IPN) is the main determinant of severity in acute pancreatitis. We aimed to statistically aggregate the available data and determine the pooled influence of OF and IPN on mortality in patients with acute pancreatitis. METHODS: The search for relevant observational studies was undertaken in the MEDLINE, EMBASE, and Scopus electronic databases, as well as in the proceedings of major gastroenterology meetings. The summary estimates are presented as relative risk (RR) and 95% confidence interval (CI). RESULTS: Fourteen studies comprising 1478 patients with acute pancreatitis were meta-analyzed. A total of 600 patients developed OF and 179 of them died (mortality, 30%); 314 patients developed IPN and 102 of them died (mortality, 32%). In a stratified analysis, patients with OF and IPN had a significantly higher risk of death in comparison with patients with OF and no IPN (RR = 1.94; 95% CI: 1.32-2.85; P = .0007) and in comparison with patients with IPN and no OF (RR = 2.65; 95% CI: 1.30-5.40; P = .0007). CONCLUSIONS: In patients with acute pancreatitis, the absolute influence of OF and IPN on mortality is comparable and thus the presence of either indicates severe disease. The relative risk of mortality doubles when OF and IPN are both present and indicates extremely severe disease or critical acute pancreatitis.