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©The Author(s) 2016.
World J Gastroenterol. Mar 7, 2016; 22(9): 2828-2836
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2828
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2828
Table 1 Definitions
Systemic inflammatory response syndrome | Occurrence of 2 or more of the followings for > 48 h: pulse > 90 beats/min; rectal temperature < 36 °C or > 38 °C; white blood cell count < 4000 or > 12000/mL; and respirations > 20/min or pCO2 < 32 mmHg |
Renal failure | Creatinine level > 177 μmol/L (2 mg/dL) after rehydration or hemofiltration or hemodialysis |
Circulatory failure | Systolic blood pressure < 90 mmHg despite adequate fluid resuscitation |
Respiratory failure | PaO2 60 mmHg or less despite FiO2 of 0.30, or need for mechanical ventilation |
Multiple organ failure | Two or more organs failed |
Preoperative respiratory infection | Positive sputum culture with or without clinical symptoms |
Colonic fistula | Discharge of large-bowel contents from a drain or a drain site or from the surgical wound |
Progressive infection | Simmering infection in which the patient has intermittent low-grade fever, with or without leukocytosis and imaging showing incomplete resolution of the necrosis, which may not be accompanied by purulent discharge from the drains |
Intra-abdominal bleeding | New fresh blood coming from drainage or wound and blood loss more than 500 mL in 24 h |
Respiratory infection | New positive microbiological results of sputum culture after surgery with or without clinical symptoms |
Postoperative sepsis | New positive blood culture/aspirate and more than one of the following clinical signs: rectal temperature < 36 °C or > 38 °C, tachycardia > 90/min, tachypnea (respiratory rate > 20/min) or hyperventilation (paCO2 < 4.3 kPa), white blood cell count < 4 × 109/L or > 12 × 109/L, or the presence of more than 10% immature neutrophils |
Table 2 Characteristics and outcomes of patients with necrosectomy n (%)
Characteristics | Outcomes |
Demographics | |
Age (yr) | 46 (21-74) |
Male sex | 220 (66) |
BMI (kg/m2) | 28 (19-35) |
Etiology | |
Biliary | 167 (50) |
Alcoholic | 43 (13) |
Others | 124 (37) |
Onset of symptoms to first intervention | |
< 2 wk | 58 (17) |
2-4 wk | 124 (37) |
> 4 wk | 152 (46) |
Severity of disease | |
APACHE-II score at admission | 8 (2-32) |
Marshall score at admission | 2 (0-12) |
Preoperative Marshall score | 2 (0-12) |
SIRS at admission | 157 (47) |
SIRS before operation | 177 (53) |
Organ failure, n | |
Single organ failure at any time before surgery | 117 (35) |
Single organ failure started at first week | 71/117 |
Persistent organ failure | 101/117 |
MOF at any time before surgery | 84 (25) |
MOF started at first week | 46/84 |
Persistent MOF | 70/84 |
Laboratory parameters | |
CRP at admission (mg/L) | 200 (17-535) |
CRP before surgery (mg/L) | 151 (8-478) |
Preoperative acidosis pH < 7.2 | 67 (20) |
Preoperative basic deficit > 5 mEq/L | 120 (36) |
Preoperative hypocalcemia (calcium level < 1.87 mmol/L) | 148 (44) |
Preoperative hypoproteinemia (albumin level < 30 g/L ) | 171 (51) |
Morphological criteria on CECT | |
Pancreatic necrosis | 285 (85) |
Extrapancreatic necrosis only | 49 (15) |
Percentage of necrosis, n | |
< 30% | 161/285 |
30%-50% | 75/285 |
> 50% | 49/285 |
CTSI before surgery | 8(4-10) |
Gas bubble signs in the retroperitoneal space | 69 (21) |
Microbiological data, n | |
Infected pancreatic necrosis | 214 (64) |
Escherichia coli | 77/214 |
Enterococcus | 64/214 |
Klebsiella | 13/214 |
Baumanii | 19/214 |
Other bacillus | 15/214 |
Fungal infection | 15/214 |
Staphylococcus | 9/214 |
Pseudomonas aeruginosa | 2/214 |
Preoperative sepsis | 107 (32) |
Operation data | |
Type of surgery | |
PCD | 102 (31) |
Minimally invasive necrosectomy | 50 (16) |
Open necrosectomy | 182 (53) |
ASA classification | |
I | 88 (26) |
II | 168 (50) |
III | 78 (24) |
Operation time, min | 138 (20-360) |
Blood transfusion during operation | 91 (27) |
Blood transfusion on the first day after surgery | 79 (23) |
Postoperative data | |
Mortality | 53 (16) |
Postoperative ICU stay (d) | 11 (0-170) |
Whole hospital stay (d) | 53 (5-220) |
Intra-abdominal hemorrhage | 50 (15) |
Colonic fistula | 68 (20) |
Progressive infection | 87 (26) |
Table 3 Factors predicting progressive sepsis
Factors | P1value | Odd ratio(lower-upper) | P2value |
Onset of symptoms to the first intervention | |||
< 2 wk | 0.093 | ||
2-4 wk | 0.938 | ||
> 4 wk | 0.176 | ||
APACHE-II score at admission | 0.150 | ||
Marshall score at admission | 0.015 | 1.723 (1.526-2.995) | 0.046 |
Preoperative Marshall score | 0.042 | 0.885 (0.607-1.290) | 0.524 |
SIRS at admission | 0.076 | ||
Preoperative SIRS | 0.001 | 0.644 (0.210-1.976) | 0.442 |
Single organ failure at any time before surgery | 0.510 | ||
MOF at any time before surgery | 0.041 | 2.031 (3.410-10.054) | 0.038 |
CRP at admission | 0.600 | ||
CRP before surgery | 0.172 | ||
Morphological criteria on CECT | |||
Pancreatic necrosis | 0.157 | ||
Extrapancreatic necrosis | 0.157 | ||
Percentage of necrosis | |||
< 30% | 0.157 | ||
30%-50% | 0.526 | ||
> 50% | 0.245 | ||
Gas bubble signs | 0.351 | ||
CTSI before surgery | 0.030 | 1.063 (0.811-1.393) | 0.66 |
Infected pancreatic necrosis | 0.274 | ||
Sepsis before surgery | 0.0001 | 11.165 (5.384-23.153) | 0.0001 |
Preoperative respiratory infection | 0.0001 | 4.304 (2.085-8.884) | 0.0001 |
Operation type | 0.082 |
Table 4 Factors predicting colonic fistula
Factors | P1value | Odd ratio(lower-upper) | P2value |
Onset of symptoms to surgery | |||
< 2 wk | 0.432 | ||
2-4 wk | 0.945 | ||
> 4 wk | 0.595 | ||
APACHE-II score at admission | 0.005 | 0.955 (0.837-1.090) | 0.497 |
Marshall score at admission | 0.007 | 0.849 (0.582-1.239) | 0.397 |
Preoperative Marshall score | 0.019 | 1.045 (0.733-1.491) | 0.807 |
SIRS at admission | 0.0001 | 2.927 (1.102-7.776) | 0.031 |
Preoperative SIRS | 0.015 | 0.554 (0.170-1.806) | 0.327 |
Single organ failure at any time before surgery | 0.001 | 6.289 (1.652-23.948) | 0.007 |
MOF at any time before surgery | 0.222 | ||
CRP level at admission | 0.001 | 1.005 (1.001-1.009) | 0.010 |
CRP level before surgery | 0.0001 | 1.003 (0.998-1.008) | 0.321 |
Hypoproteinemia before surgery | 0.0001 | 1.564 (0.750-3.265) | 0.233 |
Pancreatic necrosis | 0.708 | ||
Extrapancreatic necrosis only | 0.708 | ||
Percentage of necrosis | |||
< 30% | 0.829 | ||
30%-50% | 0.738 | ||
> 50% | 0.762 | ||
CTSI before surgery | 0.249 | ||
Gas bubble signs | 0.047 | 2.150 (0.933-4.955) | 0.321 |
Infected pancreatic necrosis | 0.506 | ||
Preoperative Sepsis | 0.519 | ||
Preoperative respiratory infection | 0.179 | ||
Preoperative ICU stay | 0.014 | 1.016 (0.973-1.060) | 0.472 |
Type of surgery | 0.328 |
Table 5 Factors predicting intra-abdominal hemorrhage
Factors | P1value | Odd ratio(lower-upper) | P2value |
APACHE-II score at admission | 0.004 | ||
Marshall score at admission | 0.0001 | 0.882 (0.626-1.243) | 0.474 |
Preoperative Marshall score | 0.0001 | 1.560 (1.003-2.426) | 0.048 |
SIRS at admission | 0.001 | 0.774 (0.274-2.185) | 0.628 |
Preoperative SIRS | 0.0001 | 1.294 (1.086-2.002) | 0.050 |
Single organ failure at any time before surgery | 0.0001 | 5.287 (1.524-7.369) | 0.031 |
MOF at any time before surgery | 0.003 | 4.327 (1.325-6.548) | 0.041 |
CRP before surgery | 0.273 | ||
Base deficit before surgery, > 5 mEq/L | 0.741 | ||
Hypoproteinemia before surgery | 0.854 | ||
Hypocalcemia before surgery | 0.006 | 1.576 (0.723-3.438) | 0.253 |
Acidosis at admission pH < 7.2 | 0.693 | ||
Pancreatic necrosis | 0.148 | ||
< 30% | 0.724 | ||
30%-50% | 0.346 | ||
> 50% | 0.923 | ||
Extra-pancreatic necrosis only | 0.148 | ||
Gas bubble signs | 0.901 | ||
CTSI before surgery | 0.053 | ||
Operation time | 0.218 | ||
Blood transfusion during operation | 0.635 | ||
Blood transfusion on the first day after surgery | 0.472 | ||
Pancreatic infection | 0.140 | ||
Preoperative sepsis | 0.048 | 1.227 (1.089-1.578) | 0.002 |
Preoperative respiratory infection | 0.240 | ||
Preoperative ICU stay | 0.055 | ||
CRRT | 0.010 | 0.810 (0.353-1.861) | 0.620 |
Type of surgery | 0.245 |
- Citation: Wei AL, Guo Q, Wang MJ, Hu WM, Zhang ZD. Early complications after interventions in patients with acute pancreatitis. World J Gastroenterol 2016; 22(9): 2828-2836
- URL: https://www.wjgnet.com/1007-9327/full/v22/i9/2828.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i9.2828