Risk Factors and Outcome for Massive Intra-Abdominal Bleeding Among Patients With Infected Necrotizing Pancreatitis.
Risk Factors and Outcome for Massive Intra-Abdominal Bleeding Among Patients With Infected Necrotizing Pancreatitis.
复制标题
感染性坏死性胰腺炎患者发生大量腹腔出血的危险因素和结果。
DOI：
10.1097/md.0000000000001172
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发表时间：
2015-07
期刊：
影响因子：
1.6
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Shen X;Sun J;Zhang J;Ke L;Tong Z;Li G;Jiang W;Li W;Li J
据报道，急性坏死性胰腺炎患者急性出血的发生率为13.5%。然而，在所有出血事件中，腹腔内出血在文献中研究较少，其危险因素尚未得到很好的定义。本研究的目的是探讨感染性坏死性胰腺炎患者腹腔内大出血的危险因素，并评估这些患者的预后。采用单因素和多因素Logistic回归模型，使用33个指标，包括年龄、性别、急性胰腺炎（AP）病因、APACHE II评分等，评估腹腔内出血的危险因素。结局评估，如死亡率、住院和重症监护室（ICU）时间以及费用，也比较了有或无腹腔内出血患者。急性肾损伤（OR：7.54，95% CI：2.53-22.52，P <0.001）和手术次数（OR：8.84，95% CI：2.01-38.86，P = 0.004）是感染性坏死性胰腺炎患者腹腔内大出血的2个预测因素。 此外，AP合并腹腔内出血患者的死亡率也明显较高，住院时间和ICU时间延长，并发症和侵入性治疗更多，费用增加。我们的研究表明，阿基和多次手术是增加感染性坏死性胰腺炎患者腹腔内出血风险的2个关键因素。此外，腹腔内大量出血也与预后不良有关。
The incidence of acute bleeding is reported to be 13.5% in patients with acute necrotizing pancreatitis. However, of all the bleeding events, intra-abdominal bleeding was less studied in the literature and its risk factors have not been well defined yet. The purpose of the present study was to investigate the risk factors for massive intra-abdominal bleeding among the patients with infected necrotizing pancreatitis and assessed the outcome of these patients. Both univariate and multivariate logistic regression models were applied for evaluating risk factors for intra-abdominal bleeding using 33 indices, including age, sex, etiology of acute pancreatitis (AP), APACHE II score, etc. Outcome assessments such as mortality, hospital and intensive care unit (ICU) durations, and cost were also compared between patients with or without intra-abdominal bleeding. Acute kidney injury (AKI) (odds ratio [OR]: 7.54, 95% confidence interval [CI]: 2.53–22.52, P < 0.001) and number of operation (OR: 8.84, 95% CI: 2.01–38.86, P = 0.004) were 2 predictors for massive intra-abdominal bleeding in the patients with infected necrotizing pancreatitis. In addition, AP patients with intra-abdominal bleeding also showed significantly higher mortality rate, prolonged hospital and ICU durations, more complications and invasive treatments, as well as increased cost. Our study revealed that AKI and multiple operations were 2 critical factors increasing the risk of intra-abdominal bleeding among patients with infected necrotizing pancreatitis. Additionally, massive intra-abdominal bleeding was also associated with poor prognosis.