Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis

Table 1 Summary of minimally invasive treatment performed for 178 patients with infectious pancreatic necrosis

Treatment	Number of patients	Percentage
PCD	35	19.66
VARD	35	19.66
LATOD	18	10.11
PCD + VARD/LATOD	78	43.82
VARD + LATOD	4	2.25
PCD + LPD	3	1.69
PCD + VARD + LATOD	5	2.81
Total	178	100

PCD: Percutaneous catheter drainage; VARD: Video-assisted retroperitoneal debridement; LATOD: Laparoscopic-assisted transomental debridement; LPD: Laparoscopic pancreatic debridement.

Table 2 Demographics of patients who underwent minimally invasive treatment for infectious pancreatic necrosis

	Patients without recurrent infection, n = 156	Patients with recurrent infection, n = 13	P value
Age in yr	53 ± 1	56 ± 4	0.435
Male sex, n (%)	96 (61.54)	6 (46.15)	0.128
Smoke, n (%)	54 (34.62)	5 (38.46)	0.224
Alcohol, n (%)	24 (15.38)	0 (0)	0.126
Medical history, n (%)
Pancreatitis	27 (17.31)	1 (7.69)	0.243
Cardiovascular Disease	10 (6.41)	2 (15.38)	0.180
Diabetes	3 (1.92)	1 (7.69)	0.246
Renal disease	8 (5.13)	0 (0)	0.520
Liver disease	14 (8.97)	0 (0)	0.311
BMI in kg/m2	23.63 ± 0.13	23.99 ± 0.43	0.430

Quantitative data are presented as the mean ± standard error of the mean. BMI: Body mass index.

Table 3 Clinical characteristics of patients who underwent minimally invasive treatment for infectious pancreatic necrosis

	Patients without recurrent infection, n = 156	Patients with recurrent infection, n = 13	P value
Time onset of IPN in d	53 ± 1	55 ± 5	0.796
Cause of IPN, n (%)
Biliary	92 (58.97)	6 (46.15)	0.543
Alcohol	23 (14.74)	3 (23.08)	0.136
Idiopathic	5 (3.21)	1 (7.69)	0.386
Hypertriglyceridemia	36 (23.08)	3 (23.08)	1.000
BISAP score	3.53 ± 0.05	3.62 ± 0.14	0.632
APACHE II score	9.56 ± 0.18	8.92 ± 0.40	0.328
Impaired mental status, n (%)	21 (13.46)	2 (15.38)	0.302
SIRS, n (%)	146 (93.59)	12 (92.31)	0.395
Pre-operative blood test
WBC as 109/L	14.59 ± 0.281	15.32 ± 0.601	0.466
BUN in mmol/L	10.45 ± 0.501	9.09 ± 0.971	0.440
Creatinine in µmol/L	156.86 ± 9.091	115.61 ± 10.601	0.195
CRP in mg/L	66.47 ± 5.631	42.66 ± 10.441	0.230
IL-6 in pg/mL	62.25 ± 7.791	53.05 ± 8.451	0.735
Procalcitonin in ng/mL	2.44 ± 0.191	2.29 ± 0.551	0.823
Minimally invasive treatment			0.157
Sole treatment with PCD/VARD/LATOD, n (%)	86 (55.13)	4 (30.77)
Combined treatment, n (%)	70 (44.87)	9 (69.23)
Post treatment blood test
WBC as 109/L	7.37 ± 0.21	11.00 ± 0.61	0.000
BUN in mmol/L	6.89 ± 0.21	6.92 ± 0.75	0.974
Creatinine in µmol/L	86.82 ± 2.78	74.85 ± 7.46	0.227
CRP in mg/L	7.68 ± 0.54	18.97 ± 3.841	0.000
IL-6 in pg/mL	8.28 ± 0.68	18.76 ± 4.241	0.000
Procalcitonin in ng/mL	0.04 ± 0.01	0.09 ± 0.01	0.000
Duration of drainage in d	79 ± 3	104 ± 13	0.025
Catheter length in cm	7.13 ± 0.26	10.68 ± 0.66	0.000

¹Abnormally higher than normal range. Quantitative data are presented as the mean ± standard error of the mean. IPN: Infectious pancreatic necrosis; BISAP: Bedside index for severity in acute pancreatitis; APACHE II: Chronic Health Evaluation II; SIRS: Systemic inflammatory response syndrome; WBC: White blood cell; BUN: Blood urea nitrogen; CRP: C-reactive protein.

Table 4 Bivariate and multivariate correlation analysis to identify factors associated with infection recurrence after drainage catheter removal

Variable	Pearson's correlation coefficient	B	Wald	P value
WBC	0.328	0.661	8.622	0.003
CRP	0.265	0.205	7.74	0.005
IL-6	0.192	0.075	2.247	0.134
Procalcitonin	0.327	24.779	4.533	0.033
Duration of drainage	0.159	0.011	0.712	0.399
Catheter length	0.277	0.589	6.032	0.014

WBC: White blood cell; CRP: C-reactive protein; IL-6: Interleukin-6.

Table 5 Cut-off value and ability of independent risk factors to predict infection recurrence

	Area under curve (95%CI)	P value	Cut-off	Sensitivity	Specificity
WBC as 109/L	× 0.856 (0.739-0.972)	0.000	9.95	0.77	0.83
CRP in mg/L	0.787 (0.670-0.904)	0.001	7.37	0.77	0.62
PCT in ng/mL	0.854 (0.767-0.941)	0.000	0.05	0.85	0.75
Catheter length in cm	0.800 (0.699-0.900)	0.000	8.05	0.85	0.61

CI: Confidence interval; WBC: White blood cell; CRP: C-reactive protein; PCT: Procalcitonin.