Background

Current guidelines for the treatment of patients with necrotizing acute pancreatitis (NAP) recommend that invasive intervention for pancreatic necrosis should be deferred to 4 or more weeks from disease onset to allow necrotic collections becoming “walled-off”. However, for patients showing signs of clinical deterioration, especially those with persistent organ failure (POF), it is controversial whether this delayed approach should always be adopted. In this study, we aimed to assess the impact of differently timed intervention on clinical outcomes in a group of NAP patients complicated by POF.

Methods

All NAP patients admitted to our hospital from January 2013 to December 2017 were screened for potential inclusion. They were divided into two groups based on the timing of initial intervention (within 4 weeks and beyond 4 weeks). All the data were extracted from a prospectively collected database.

Results

Overall, 131 patients were included for analysis. Among them, 100 (76.3%) patients were intervened within 4 weeks and 31 (23.7%) underwent delayed interventions. As for organ failure prior to intervention, the incidences of respiratory failure, renal failure and cardiovascular failure were not significantly different between the two groups (P > 0.05). The mortality was not significantly different between the two groups (35.0% vs. 32.3%, P = 0.83). The incidences of new-onset multiple organ failure (8.0% vs. 6.5%, P = 1.00), gastrointestinal fistula (29.0% vs. 12.9%, P = 0.10) and bleeding (35.0% vs. 35.5%, P = 1.00), and length of ICU (30.0 vs. 22.0 days, P = 0.61) and hospital stay (42.5 vs. 40.0 days, P = 0.96) were comparable between the two groups.

Conclusion

Intervention within 4 weeks did not worsen the clinical outcomes in NAP patients complicated by POF.

中文翻译：

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坏死性急性胰腺炎并发持续性器官衰竭的早期干预与延迟干预

背景

目前治疗坏死性急性胰腺炎 (NAP) 患者的指南建议，胰腺坏死的侵入性干预应推迟到疾病发作后 4 周或更长时间，以使坏死聚集物变得“封闭”。然而，对于表现出临床恶化迹象的患者，尤其是那些有持续性器官衰竭 (POF) 的患者，是否应始终采用这种延迟方法存在争议。在本研究中，我们旨在评估不同时间干预对一组并发 POF 的 NAP 患者临床结果的影响。

方法

对 2013 年 1 月至 2017 年 12 月入院的所有 NAP 患者进行了潜在纳入筛查。根据初始干预的时间（4 周内和 4 周后）将他们分为两组。所有数据均从前瞻性收集的数据库中提取。

结果

总体而言，131 名患者被纳入分析。其中，4周内干预100例（76.3%），延迟干预31例（23.7%）。对于干预前的器官衰竭，两组呼吸衰竭、肾衰竭和心血管衰竭的发生率差异无统计学意义（P  > 0.05）。两组的死亡率没有显着差异（35.0% vs. 32.3%，P  = 0.83）。新发多器官衰竭（8.0% vs. 6.5%，P  = 1.00）、胃肠瘘（29.0% vs. 12.9%，P  = 0.10）和出血（35.0% vs. 35.5%，P  = 1.00）的发生率和 ICU 的长度（30.0 天 vs. 22.0 天，P = 0.61）和住院时间（42.5 vs. 40.0 天，P  = 0.96）在两组之间具有可比性。

结论

4 周内的干预并未使 NAP 合并 POF 患者的临床结果恶化。