Early versus delayed intervention in necrotizing acute pancreatitis complicated by persistent organ failure

• 作者: He Zhang Lin Gao Wen-Jian Mao Jie Yang Jing Zhou Zhi-Hui Tong Lu Ke Wei-Qin Li
• 来源期刊: 国际肝胆胰疾病杂志（英文版）
• 年，卷（期）: 2022,（1）
• 所属期刊栏目: PANCREAS
• 页码范围: 63-68
• 页数: 6页
• 语种: 英文

摘要

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 interven- tion (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 in- tervened 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 signifi- cantly 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 com- parable between the two groups. Conclusion: Intervention within 4 weeks did not worsen the clinical outcomes in NAP patients compli- cated by POF.