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

Academic Article
Publication Date:
2023
Short description:
Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study / Podda, M., Pellino, G., Di Saverio, S., Coccolini, F., Pacella, D., Cioffi, S.P.B., Virdis, F., Balla, A., Ielpo, B., Pata, F., Poillucci, G., Ortenzi, M., Damaskos, D., De Simone, B., Sartelli, M., Leppaniemi, A., Jayant, K., Catena, F., Giuliani, A., Di Martino, M., et al.. - In: UPDATES IN SURGERY. - ISSN 2038-131X. - 75:3(2023), pp. 493-522. [10.1007/s13304-023-01488-6]
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). Graphical abstract: [Figure not available: see fulltext.].
Iris type:
1.1 Articolo in rivista
List of contributors:
Podda, M.; Pellino, G.; Di Saverio, S.; Coccolini, F.; Pacella, D.; Cioffi, S. P. B.; Virdis, F.; Balla, A.; Ielpo, B.; Pata, F.; Poillucci, G.; Ortenzi, M.; Damaskos, D.; De Simone, B.; Sartelli, M.; Leppaniemi, A.; Jayant, K.; Catena, F.; Giuliani, A.; Di Martino, M.; Pisanu, A.; Gerardi, C.; Gourgiotis, S.; Riboni, C.; Giordano, A.; Ferrario, L.; Agnoletti, V.; Kruger, Y.; Mole, D.; Agresta, F.; Prieto Calvo, M.; Wilson, M.; Soggiu, F.; Hamdan, A.; Gomes, C. A.; Fraga, G.; Ioannidis, A.; Demetrashvili, Z.; Sahani, S.; Bains, L.; Khamees, A.; Ababneh, H.; Aljaiuossi, O.; Pimentel, S.; Mohamad, I. S.; Yusoff, A. R.; Zarnescu, N. O.; Calu, V.; Litvin, A.; Lesko, D.; Elmehrath, A.; Elshami, M.; De Santibanes, M.; Gundara, J.; Alawadhi, K.; Lui, R.; Julianov, A.; Ralon, S.; Garzali, I. -U.; Machain, G. M.; Villalabeitia, I.; Quispe-Cruz, D. A.; Orantia, A. C. C.; Waledziak, M.; De Sa, T. C.; Ali, S. M.; Kovacevic, B.; Noel, C.; Abdalah, H. M.; Kchaou, A.; Isik, A.; Ansaloni, L.; Biffl, W.; Guerrieri, M.; Sartori, A.; Abradelo, M.; Nigri, G.; Di Lorenzo, N.; Mingoli, A.; Chiarugi, M.; Di Menno Stavron, J.; Mazza, O.; Valenzuela, J. I.; Pachajoa, D. A. P.; Alvarez, F. A.; Liano, J. E.; Tefay, J.; Alshaikh, A.; Hasan, L.; Couto Gomes, F.; Calderan, T. R. A.; Hirano, E. S.; Dardanov, D.; Julianov, A.; Saroglu, A.; Atanasov, B.; Belev, N.; Kovachev, N.; Chan, S. M.; Lok, H. -T.; Salcedo, D.; Robayo, D.; Trivino, M. A.; Manak, J.; Sahani, S.; De Araujo, J.; Sethi, A.; Awad, A.; Elbadawy, M.; Farid, A.; Hanafy, A.; Nafea, A.; Sherief, G.; Salah Alzhraa, A.; Abdelsalam, W.; Emile, S.; Elfallal, A.; Elfeki, H.; Elghadban, H.; Shoma, A.; Shetiwy, M.; Elbahnasawy, M.; Mohamed, S.; Hamed, E. F.; Khalil, U. A.; Chouillard, E.; Gumbs, A.; Police, A.; Mabilia, A.; Khutsishvili, K.; Tvaladze, A.; Ioannidis, O.; Anestiadou, E.; Loutzidou, L.; Konstantinidis, K.; Konstantinidou, S.; Manatakis, D.; Acheimastos, V.; Tasis, N.; Michalopoulos, N.; Kokoropoulos, P.; Papadoliopoulou, M.; Sotiropoulou, M.; Kapiris, S.; Metaxas, P.; Tsouknidas, I.; Kefili, D.; Petrakis, G.; Synekidou, E.; Dakis, K.; Alexandridou, E.; Papadopoulos, A.; Chouliaras, C.; Mouzakis, O.; Mulita, F.; Maroulis, I.; Vailas, M.; Triantafyllou, T.; Theodorou, D.; Lostoridis, E.; Nagorni, E. -A.; Tourountzi, P.; Baili, E.; Charalabopoulos, A.; Liakakos, T.; Schizas, D.; Kozadinos, A.; Syllaios, A.; Machairas, N.; Kykalos, S.; Stamopoulos, P.; Delis, S.; Farazi-Chongouki, C.; Kalaitzakis, E.; Giannarakis, M.; Lasithiotakis, K.; Petra, G.; Kalaitzakis, E.; Gupta, A.; Medappil, N.; Muthukrishnan, V.; Kamar, J.; Lal, P.; Agarwal, R.; Magnoli, M.; Aonzo, P.; Serventi, A.; Di Lascio, P.; Pinto, M.; Bergamini, C.; Bottari, A.; Fortuna, L.; Martellucci, J.; Cicako, A.; Miglietta, C.; Morino, M.; Delogu, D.; Picchetto, A.; Assenza, M.; D'Ambrosio, G.; Argenio, G.; Armellino, M. F.; Ioia, G.; Occhionorelli, S.; Andreotti, D.; Domenico, L.; Luppi, D.; Casadei, M.; Di Donato, L.; Manoochehri, F.; Marchese, T. R. L.; Sergi, W.; Manca, R.; Murgia, R.; Piras, E.; Conti, L.; Gianazza, S.; Rizzi, A.; Segalini, E.; Monti, M.; Iiritano, E.; Mariani, N. M.; De Nicola, E.; Scifo, G.; Pignata, G.; Andreuccetti, J.; Fleres, F.; Clarizia, G.; Spolini, A.; Biloslavo, A.; Germani, P.; Mastronardi, M.; Bogoni, S.; Palmisano, S.; De Manzini, N.; Marino, M. V.; Martines, G.; Trigiante, G.; Lagouvardou, E.; Anania, G.; Bombardini, C.; Oppici, D.; Pilia, T.; Murzi, V.; Gessa, E.; Bracale, U.; Di Nuzzo, M. M.; Peltrini, R.; Salvetti, F.; Vigano, J.; Sganga, G.; Bianchi, V.; Fransvea, P.; Fontana, T.; Sarro, G.; Dinuzzi, V. P.; Scaravilli, L.; Papa, M. V.; Jovine, E.; Ciabatti, G.; Mastrangelo, L.; Rottoli, M.; Ricci, C.; Russo, I. S.; Aiolfi, A.; Bona, D.; Lombardo, F.; Cianci, P.; Sederino, M.; Bini, R.; Chiara, O.; Cantafio, S.; Coretti, G.; Licitra, E.; Savino, G.; Grimaldi, S.; Porfidia, R.; Moggia, E.; Garino, M.; Marafante, C.; Pesce, A.; Fabbri, N.; Feo, C. V.; Marra, E.; Troian, M.; Drigo, D.; Nagliati, C.;
Authors of the University:
OLMI STEFANO PAOLO
Handle:
https://iris.unisr.it/handle/20.500.11768/175518
Full Text:
https://iris.unisr.it//retrieve/handle/20.500.11768/175518/322313/unpaywall-bitstream--842685906.pdf
https://iris.unisr.it//retrieve/handle/20.500.11768/175518/322341/unpaywall-bitstream-1489339543.pdf
Published in:
UPDATES IN SURGERY
Journal
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