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Clinical Trial
. 2023 Apr;75(3):493-522.
doi: 10.1007/s13304-023-01488-6. Epub 2023 Mar 11.

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Mauro Podda  1 , Gianluca Pellino  2   3 , Salomone Di Saverio  4 , Federico Coccolini  5 , Daniela Pacella  6 , Stefano Piero Bernardo Cioffi  7 , Francesco Virdis  7 , Andrea Balla  8 , Benedetto Ielpo  9 , Francesco Pata  10 , Gaetano Poillucci  11 , Monica Ortenzi  12 , Dimitrios Damaskos  13 , Belinda De Simone  14 , Massimo Sartelli  15 , Ari Leppaniemi  16 , Kumar Jayant  17 , Fausto Catena  18 , Antonio Giuliani  19 , Marcello Di Martino  20 , Adolfo Pisanu  21 ; MANCTRA-1 Collaborative Group
Collaborators, Affiliations
Clinical Trial

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Mauro Podda et al. Updates Surg. 2023 Apr.

Abstract

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990).

Keywords: Acute pancreatitis; Infected pancreatic necrosis; International study; Mortality; Organ failure.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) Flow-Diagram
Fig. 2
Fig. 2
Intensive care unit (ICU) admission prediction model
Fig. 3
Fig. 3
Mortality prediction model
See this image and copyright information in PMC

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