Risk Factors and Outcome of Splanchnic venous thrombosis in Patients with necrotizing acute pancreatitis
Risk Factors and Outcome of Splanchnic venous thrombosis in Patients with necrotizing acute pancreatitis
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DOI：
10.1016/j.thromres.2014.10.021
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发表时间：
2015-01-01
影响因子：
7.5
通讯作者：
Li, Jieshou
中科院分区：
文献类型：
--
作者：
Zhou, Jing;Ke, Lu;Li, Jieshou
背景：内脏静脉血栓（SVT）被认为是急性胰腺炎（AP）患者罕见但重要的并发症，有关该主题的文献很少。本研究旨在探讨坏死性急性胰腺炎（NAP）患者发生SVT的危险因素并评估其预后。方法：采用单因素和多因素Logistic回归分析，对年龄、性别、急性生理和慢性健康评估II评分（APACHE II）、CRP（C反应蛋白）水平等15项指标进行分析，探讨NAP患者发生SVT的潜在危险因素。此外，还比较了伴或不伴SVT的NAP患者的死亡率、器官衰竭、住院时间和ICU住院时间等临床结局指标。结果：根据统计结果，只有腹内压（IAP）被证明是SVT的独立危险因素（OR，1.283；95% CI，1.091-1.509，P = 0.003）。此外，Balthazar的CT评分和IPN（感染性胰腺坏死）的发生率也达到统计学显着性（分别为P = 0.040和0.047），但多变量logistic回归显示的95%置信区间表明观察到的OR并不显着（1.326；95% CI 0.984-1.787和2.61；95 CI 0.972-7.352，分别），这表明两个参数和 SVT 之间的关联较弱。在临床结局方面，SVT患者死亡率较高、住院和重症监护病房时间较长、各种并发症发生率较高以及侵入性干预的使用较多。结论：IAP是NAP患者发生SVT的独立危险因素，Balthazar的CT评分和IPN的发生也与SVT相关，但不如IAP强。此外，SVT 的发生与 NAP 患者的预后极差有关，死亡率、发病率增加和对侵入性干预的需求增加就证明了这一点。 (C) 2014 Elsevier Ltd. 保留所有权利。
Background: Splanchnic venous thrombosis (SVT) is considered a rare but important complication in patients with acute pancreatitis (AP) and literatures regarding this topic were sparse. The aim of the present study was to investigate the risk factors of SVT in necrotizing acute pancreatitis (NAP) and assess the prognosis of these patients.Methods: Both univariate and multivariate logistic regression analyses were applied using 15 indices including age, gender, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), CRP (C-reactive protein) levels, etc to explore potential risk factors for the development of SVT in NAP patients. Moreover, clinical outcome measures such as mortality, organ failure and length of hospital and ICU stay were also compared between NAP patients with or without SVT.Results: According to the statistical results, only intra-abdominal pressure (IAP) was proved to be an independent risk factor for SVT (OR, 1.283; 95% CI, 1.091-1.509, P = 0.003). In addition, Balthazar's CT score and occurrence of IPN (infected pancreatic necrosis) also reached statistical significance (P = 0.040 and 0.047, respectively), but the 95% confidence interval shown in the multivariate logistic regression suggested that the observed ORs are not significant (1.326; 95% CI 0.984-1.787 and 2.61; 95 CI 0.972-7.352, respectively), which indicates weaker association between the two parameters and SVT. Regarding the clinical outcomes, patients with SVT showed higher mortality, longer hospital and intensive care unit duration, higher rates of a variety of complications and more utilization of invasive interventions.Conclusions: IAP is an independent risk factor for the development of SVT in patients with NAP, while Balthazar's CT score and occurrence of IPN are also associated with SVT, although not as strong as IAP. Moreover, occurrence of SVT relates with extremely poor prognosis in NAP patients, evidenced by increased mortality, morbidity and need for invasive interventions. (C) 2014 Elsevier Ltd. All rights reserved.