Early complications after interventions in patients with acute pancreatitis

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)

BMI: Body mass index, calculated as weight in kilograms divided by height in meters squared; APACHE: Acute physiology and chronic health examination; ICU: Intensive care unit; CRP: C-reactive protein; MOF: Multiple organ failure; CECT: Contrast-enhanced computed tomography; CTSI: Computed tomography severity index; SIRS: Systemic inflammatory response syndrome; PCD: Percutaneous catheter drainage.

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

P₁ indicated two-sided P value of univariate analysis; P₂ indicated two-sided P value of multivariate analysis. APACHE: Acute physiology and chronic health examination; ICU: Intensive care unit; CRP: C-reactive protein; MOF: Multiple organ failure; CECT: Contrast-enhanced computed tomography; CTSI: Computed tomography severity index; SIRS: Systemic inflammatory response syndrome.

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

P₁ indicated two-sided P value of univariate analysis; P₂ indicated two-sided P value of multivariate analysis. APACHE: Acute physiology and chronic health examination; ICU: Intensive care unit; CRP: C-reactive protein; MOF: Multiple organ failure; CECT: Contrast-enhanced computed tomography; CTSI: Computed tomography severity index; SIRS: Systemic inflammatory response syndrome; PCD: Percutaneous catheter drainage.

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

P₁ indicated two-sided P value of univariate analysis; P₂ indicated two-sided P value of multivariate analysis. APACHE: Acute physiology and chronic health examination; ICU: Intensive care unit; CRP: C-reactive protein; MOF: Multiple organ failure; CECT: Contrast-enhanced computed tomography; CTSI: Computed tomography severity index; SIRS: Systemic inflammatory response syndrome; CRRT: Continuous renal replacement therapy; PCD: Percutaneous catheter drainage.