Effects of infective necrosis on poor prognosis in acute pancreatitis

Abstract

Objective To evaluate the effects of infective necrosis (IN) on prognosis in moderately severe or severe acute pancreatitis (AP). Methods According to the revision of Atlanta classification, from January 2001 to January 2015, admitted patients with moderately severe or severe AP were retrospectively analyzed. According to whether with the presence of persistent organ failure (POF) and /or IN, the patients were divided into four groups: group one with weither IN nor POF, group two with IN but without POF, group three with POF but without IN, group four with both IN and POF. The differences in disease severity and prognosis among groups were compared. Logistic regression and Cox proportional hazard regression model were used to analyze the effect of IN on prognosis. Results A total of 375 moderately severe or severe AP patients were enrolled. There were 211, 43, 90 and 31 patients in group one, two, three and four, respectively. A total of 121 (32.3%) patients with POF, 74 (19.7%) patients with IN, and death in 63 (16.8%) patients. The mortality rate in patients with IN was 32.4%(24/74), and which was 13.0%(39/301) in patients without IN. The mortality rates of group one, two, three and four were 1.9%(4/211), 11.6%(5/43), 38.9%(35/90) and 61.3%(19/31), respectively; mortality rate was in a trend of increasing, and the difference was statistically significant (χ2=109.672, P<0.01). Both IN (OR=8.24, 95%CI 2.09 to 32.46) and POF (OR=8.31, 95% CI 2.48 to 27.87) were independent risk factors of mortality of AP patients (both P<0.01). Both IN (OR=2.04, 95%CI 1.19 to 3.48, 0.002) and POF (OR=5.25, 95%CI 2.36 to 11.65) also were independent risk factors of shortened survival time of AP patients (both P<0.01). Conclusions IN is an independent risk factor of disease severity and poor prognosis in AP. The prognosis is the worst in AP patients with both POF and IN. Key words: Acute pancreatitis; Severe acute pancreatitis; Infective necrosis; Organ failure; Mortality; Prognosis