Pancreatic Necrosis Infection as a Determinant of Multiple Organ Failure and Mortality in Acute Pancreatitis

Pathogens · 6 authors, 4 centres

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TL;DR

The central result was that ERAS significantly reduced minor postoperative complications and hospital length of stay, but did not significantly affect mortality rates.

Full summary

775 CHARS

The cohort included 148 patients, with a subgroup analysis focusing on infected ANP. Statistical analysis showed that the ERAS group had a significantly lower frequency of minor complications requiring conservative or non-general anesthesia surgical treatment (9.5% vs. However, no statistically significant differences were observed between the groups in the incidence of severe complications (grade IIIb) or life-threatening complications like multiple organ failure (MOF). Regression analysis indicated that pre- and post-operative MOF were strong predictors of mortality. Limitations noted include a retrospective design based on medical records, potential selection bias by focusing on patients with infected ANP, and the need for further verification in larger cohorts.

STUDY TYPE

cohort

SPECIALTY

surgery

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ORIGINAL PAPER

PMC10054645

Pancreatic Necrosis Infection as a Determinant of Multiple Organ Failure and Mortality in Acute Pancreatitis

Pathogens

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ABSTRACT

Abstract Several recommendations and data on the treatment of acute necrotizing pancreatitis (ANP) are conflicting and different surgical approaches continue to exist. We conducted a study on 148 patients with ANP, who were divided into two groups: the main group ( n = 95) when the tactics of the step-up approach were applied with the principles of the concept of Enhanced Recovery After Surgery (ERAS) in order to determine this approach on effectiveness in reducing complications and 30-day mortality (2017–2022); the comparison group ( n = 53) when the same tactic of the treatment was used without ERAS principles (2015–2016). Treatment time for the main group in the intensive care unit was minimized ( p ≤ 0.004 ); it has been shown to reduce the frequency of complications in these patients ( p < 0.001 ) requiring conservative or surgical treatment without general anaesthesia (Clavien-Dindo I-IIIa); no statistically significant differences were observed for the total incidence of Clavien-Dindo IIIb-IVb complications ( p > 0.05); the median duration of treatment for patients in the primary group was 23 days, and in the reference group—34 days ( p ≤ 0.003 ). Pancreatic infections have been observed in 92 (62.2%) patients and gram-negative bacteria predominated in the overall pathogen structure with 222 (70.7%) strains. The only evidence of multiple organ failure before ( AUC = 0.814 ) and after surgery ( AUC = 0.931 ) was found to be predictive of mortality. Antibiotic sensitivity of all isolated bacteria better understood local epidemiology and identified the most effective antibiotics when treating patients. Keywords: acute necrotizing pancreatitis, pancreatic infection, treatment, bacterial strains, antibiotics, multiple organ failure, mortality

CITATION EXPORT

Igor A Kryvoruchko, Valeriy V Boyko, Massimo Sartelli et al.. Pancreatic Necrosis Infection as a Determinant of Multiple Organ Failure and Mortality in Acute Pancreatitis. Pathogens. (2023). https://doi.org/10.3390/pathogens12030428

AUTHORS

6 · 4 CENTRES

Igor A Kryvoruchko, Valeriy V Boyko, Massimo Sartelli, Yulia V Ivanova, Denys O Yevtushenko, Andrij S Honcharov

1Department of Surgery No.2, Kharkiv National Medical University, Nezalezhnosti Avenue, 61022 Kharkiv, Ukraine; [email protected]
2Institute General and Emergency Surgery Named after V.T. Zaitcev of the National Academy of Medical Sciences of Ukraine, Balakireva Entry, 61103 Kharkiv, Ukraine; [email protected]
3Department of Surgery No.1, Kharkiv National Medical University, Balakireva Entry, 61103 Kharkiv, Ukraine; [email protected] (Y.V.I.); [email protected] (D.O.Y.)
4Department of Surgery, Macerata Hospital, Santa Lucia Street, 62100 Macerata, Italy; [email protected]