TY - JOUR
T1 - Infected pancreatic necrosis
T2 - outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
AU - the MANCTRA-1 Collaborative Group
AU - Podda, Mauro
AU - Pellino, Gianluca
AU - Di Saverio, Salomone
AU - Coccolini, Federico
AU - Pacella, Daniela
AU - Cioffi, Stefano Piero Bernardo
AU - Virdis, Francesco
AU - Balla, Andrea
AU - Ielpo, Benedetto
AU - Pata, Francesco
AU - Poillucci, Gaetano
AU - Ortenzi, Monica
AU - Damaskos, Dimitrios
AU - De Simone, Belinda
AU - Sartelli, Massimo
AU - Leppaniemi, Ari
AU - Jayant, Kumar
AU - Catena, Fausto
AU - Giuliani, Antonio
AU - Di Martino, Marcello
AU - Pisanu, Adolfo
AU - Gerardi, Chiara
AU - Gourgiotis, Stavros
AU - Riboni, Cristiana
AU - Giordano, Alessio
AU - Ferrario, Luca
AU - Agnoletti, Vanni
AU - Kruger, Yoram
AU - Mole, Damian
AU - Agresta, Ferdinando
AU - Prieto Calvo, Mikel
AU - Wilson, Michael
AU - Soggiu, Fiammetta
AU - Hamdan, Alaa
AU - Gomes, Carlos Augusto
AU - Fraga, Gustavo
AU - Ioannidis, Argyrios
AU - Demetrashvili, Zaza
AU - Sahani, Saaz
AU - Bains, Lovenish
AU - Khamees, Almu’atasim
AU - Ababneh, Hazim
AU - Aljaiuossi, Osama
AU - Pimentel, Samuel
AU - Mohamad, Ikhwan Sani
AU - Yusoff, Ahmad Ramzi
AU - Zarnescu, Narcis Octavian
AU - Calu, Valentin
AU - Litvin, Andrey
AU - Lesko, Dusan
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/4/1
Y1 - 2023/4/1
N2 - The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].
AB - The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].
KW - Acute pancreatitis
KW - Infected pancreatic necrosis
KW - International study
KW - Mortality
KW - Organ failure
UR - http://www.scopus.com/inward/record.url?scp=85149769690&partnerID=8YFLogxK
U2 - 10.1007/s13304-023-01488-6
DO - 10.1007/s13304-023-01488-6
M3 - Article
SN - 2038-131X
VL - 75
SP - 493
EP - 522
JO - Updates in Surgery
JF - Updates in Surgery
IS - 3
ER -