Robert A Moran1, Christopher Halloran2, Qiang Guo3, Chandra Umapathy4, Niloofar Y Jalaly5, Saransh Jain6, Darren Cowzer7, Enrique Perez Cuadrado Robles8, Noé Quesada-Vázquez9, Andrea Szentesi10, Mária Papp11, Tiffany Chua12, Katalin Márta13, Kartik Sampath14, David X Jin15, Shaheel Mohammad Sahebally16, Tobias Philipp Kuschnereit17, Mouen A Khashab5, Clare Rock5, Erika Darvasi18, Rebecca Saunders2, Guillermo García-Rayado19, Yolanda Sánchez Torrijos9, Laoise Coady16, Georgios I Papachristou4, Julia Mayerle20, Justin Geoghegan16, Peter A Banks15, Timothy B Gardner21, Anikó Nóra Szabó13, Tyler Stevens12, Tamás Tornai11, Emese Tóth18, Gerry McEntee7, Pramod K Garg6, Péter Hegyi22, Dhiraj Yadav4, Weiming Hu23, John Neoptolemos24, Vikesh K Singh25. 1. Department of Gastroenterology, Medical University of South Carolina, Charleston, SC, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: moranr@musc.edu. 2. University of Liverpool, Liverpool, United Kingdom. 3. Department of Vascular Surgery, West China Hospital Chengdu, Chengdu, China. 4. University of Pittsburgh Medical Center, Pittsburgh, PA, United States. 5. Johns Hopkins University School of Medicine, Baltimore, MD, United States. 6. All Indian Institute of Medical Sciences, New Delhi, India. 7. Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. 8. Morales Meseguer Hospital, Murcia, Spain. 9. Hospital Universitario Virgen Del Rocio, Seville, Spain. 10. First Department of Medicine, University of Szeged, Szeged, Hungary; Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary. 11. Institute of Medicine, Department of Gastroenterology, University of Debrecen, Debrecen, Hungary. 12. Cleveland Clinic, Cleveland, OH, United States. 13. Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary. 14. Weill Cornell Medical College, New York City, NY, United States. 15. Brigham and Women's Hospital, Boston, MA, United States. 16. Department of Surgery, St Vincents University Hospital, Dublin, Ireland. 17. University of Greifswald, Greifswald, Germany. 18. First Department of Medicine, University of Szeged, Szeged, Hungary. 19. Hospital General Universitario de Alicante, Alicante, Spain. 20. Ludwig-Maximilians-University of Munich, Munich, Germany. 21. Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States. 22. MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary. 23. Department of Pancreatic Surgery, West China Hospital, Chengdu, China. 24. Department of Surgery, University of Heidelberg, Heidelberg, Germany. 25. Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: vsingh1@jhmi.edu.
Abstract
BACKGROUND: Mortality in infected pancreatic necrosis (IPN) is dynamic over the course of the disease, with type and timing of interventions as well as persistent organ failure being key determinants. The timing of infection onset and how it pertains to mortality is not well defined. OBJECTIVES: To determine the association between mortality and the development of early IPN. METHODS: International multicenter retrospective cohort study of patients with IPN, confirmed by a positive microbial culture from (peri) pancreatic collections. The association between timing of infection onset, timing of interventions and mortality were assessed using Cox regression analyses. RESULTS: A total of 743 patients from 19 centers across 3 continents with culture-confirmed IPN from 2000 to 2016 were evaluated, mortality rate was 20.9% (155/734). Early infection was associated with a higher mortality, when early infection occurred within the first 4 weeks from presentation with acute pancreatitis. After adjusting for comorbidity, advanced age, organ failure, enteral nutrition and parenteral nutrition, early infection (≤4 weeks) and early open surgery (≤4 weeks) were associated with increased mortality [HR: 2.45 (95% CI: 1.63-3.67), p < 0.001 and HR: 4.88 (95% CI: 1.70-13.98), p = 0.003, respectively]. There was no association between late open surgery, early or late minimally invasive surgery, early or late percutaneous drainage with mortality (p > 0.05). CONCLUSION: Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.
BACKGROUND: Mortality in infected pancreatic necrosis (IPN) is dynamic over the course of the disease, with type and timing of interventions as well as persistent organ failure being key determinants. The timing of infection onset and how it pertains to mortality is not well defined. OBJECTIVES: To determine the association between mortality and the development of early IPN. METHODS: International multicenter retrospective cohort study of patients with IPN, confirmed by a positive microbial culture from (peri) pancreatic collections. The association between timing of infection onset, timing of interventions and mortality were assessed using Cox regression analyses. RESULTS: A total of 743 patients from 19 centers across 3 continents with culture-confirmed IPN from 2000 to 2016 were evaluated, mortality rate was 20.9% (155/734). Early infection was associated with a higher mortality, when early infection occurred within the first 4 weeks from presentation with acute pancreatitis. After adjusting for comorbidity, advanced age, organ failure, enteral nutrition and parenteral nutrition, early infection (≤4 weeks) and early open surgery (≤4 weeks) were associated with increased mortality [HR: 2.45 (95% CI: 1.63-3.67), p < 0.001 and HR: 4.88 (95% CI: 1.70-13.98), p = 0.003, respectively]. There was no association between late open surgery, early or late minimally invasive surgery, early or late percutaneous drainage with mortality (p > 0.05). CONCLUSION: Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.
Authors: Balázs Kui; József Pintér; Roland Molontay; Marcell Nagy; Nelli Farkas; Noémi Gede; Áron Vincze; Judit Bajor; Szilárd Gódi; József Czimmer; Imre Szabó; Anita Illés; Patrícia Sarlós; Roland Hágendorn; Gabriella Pár; Mária Papp; Zsuzsanna Vitális; György Kovács; Eszter Fehér; Ildikó Földi; Ferenc Izbéki; László Gajdán; Roland Fejes; Balázs Csaba Németh; Imola Török; Hunor Farkas; Artautas Mickevicius; Ville Sallinen; Shamil Galeev; Elena Ramírez-Maldonado; Andrea Párniczky; Bálint Erőss; Péter Jenő Hegyi; Katalin Márta; Szilárd Váncsa; Robert Sutton; Peter Szatmary; Diane Latawiec; Chris Halloran; Enrique de-Madaria; Elizabeth Pando; Piero Alberti; Maria José Gómez-Jurado; Alina Tantau; Andrea Szentesi; Péter Hegyi Journal: Clin Transl Med Date: 2022-06