Discrepancy Between the Extent of Pancreatic Necrosis and Multiple Organ Failure Score in Severe Acute Pancreatitis
Discrepancy Between the Extent of Pancreatic Necrosis and Multiple Organ Failure Score in Severe Acute Pancreatitis
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DOI：
10.1007/s00268-009-0161-9
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发表时间：
2009-11-01
影响因子：
2.6
通讯作者：
Parks, Rowan W.
中科院分区：
文献类型：
--
作者：
Mole, Damian J.;McClymont, Katie L.;Parks, Rowan W.
胰腺坏死是否是重症急性胰腺炎（AP）发生多器官功能衰竭（MOF）的先决条件尚不清楚，这对合理设计转化治疗有影响。方法回顾性分析276例AP患者的临床表现、MOF严重程度、胰腺坏死的CT表现、结果276例患者中有160例的坏死与MOF状态一致（58%; 95%置信区间（CI），52.1-63.8%）。在276次发作中，有116次的MCTSI和MOF评分不一致（42%; 95% CI，36.2-47.9%）。104例无任何MOF证据的患者中有21例（20.2%）存在胰腺坏死的CT证据，176例MOF患者中有95例（54%）的CT扫描无坏死证据。全因素单变量分析表明，CT上看到的胰外并发症，特别是腹腔积液，（效应量= 0.02; P = 0.016）和肝脏异常强化（效应量= 0.035; P = 0.031）与MOF的严重程度相关，结论AP中坏死的存在与MOF的发生之间的差异有利于AP中坏死的存在与MOF的发生之间的联系，而不是原因。一个复杂的，系统为基础的，多效性炎症网络与一个共同的根源，其中胰腺坏死的程度影响的严重程度，在某些个人和MOF加剧胰腺坏死的发展，在其他人，似乎更有可能。
Background Whether pancreatic necrosis is a prerequisite for the development of multiorgan failure (MOF) in severe acute pancreatitis (AP) is not clear and has implications for the rational design of translational therapies. This study was designed to investigate the magnitude of any association between MOF and radiologically evident pancreatic or extrapancreatic complications of AP.Methods Data regarding 276 patients with AP were analyzed retrospectively with regard to clinical presentation, MOF severity, computerized tomography (CT) evidence of pancreatic necrosis, and modified CT severity index (MCTSI).Results Agreement between the presence of necrosis and MOF status was seen in 160 of 276 patient episodes (58%; 95% confidence intervals (CI), 52.1-63.8%). In 116 of 276 episodes, the MCTSI and MOF scores disagreed (42%; 95% CI, 36.2-47.9%). CT evidence of pancreatic necrosis was present in 21 of 104 (20.2%) patients without any evidence of MOF, and there was no evidence of necrosis on CT scan in 95 of 176 (54%) patients with MOF. Full-factorial univariate analysis suggested that extrapancreatic complications seen on CT, in particular intra-abdominal fluid collections (effect size = 0.02; P = 0.016) and abnormal liver enhancement (effect size = 0.035; P = 0.031) were associated with severity of MOF, and exerted an even greater effect when they occurred synchronously.Conclusions The discrepancy between the presence of necrosis and the occurrence of MOF favors association but not cause in AP. A complex, systems-based, pleiotropic inflammatory network with a common root, in which the extent of pancreatic necrosis influences the severity of MOF in certain individuals and MOF exacerbates the development of pancreatic necrosis in others, seems more likely.