Prognostic factors analysis of ultrasound-guided percutaneous puncture drainage in severe acute pancreatitis with peripancreatic fluid collection

Table 1 Baseline characteristics of study population (n = 134), n (%)/mean ± SD/median (interquartile range)

Characteristic	Total (n = 134)	Good prognosis (n = 82)	Poor prognosis (n = 52)	P value
Age (years)	51.6 ± 13.4	49.2 ± 12.8	55.1 ± 13.9	0.009
Male gender	88 (65.7)	53 (64.6)	35 (67.3)	0.746
Etiology: Biliary	56 (41.8)	38 (46.3)	18 (34.6)	0.178
Etiology: Hypertriglyceridemia	42 (31.3)	24 (29.3)	18 (34.6)	0.512
Etiology: Alcoholic	24 (17.9)	14 (17.1)	10 (19.2)	0.753
APACHE II score	16.8 ± 5.2	14.3 ± 4.6	20.6 ± 4.8	< 0.001
CTSI	7.4 ± 1.9	6.8 ± 1.7	8.3 ± 1.8	< 0.001
CRP (mg/L)	248.6 (168.4-362.5)	198.3 (134.2-286.4)	318.7 (242.6-412.8)	< 0.001
Procalcitonin (ng/mL)	3.8 (1.2-9.6)	2.4 (0.8-5.8)	7.2 (3.4-15.6)	< 0.001
Organ failure at admission	68 (50.7)	32 (39.0)	36 (69.2)	< 0.001
Number of organ failures	1.4 ± 0.9	0.9 ± 0.8	2.1 ± 0.8	< 0.001
Fluid collection volume (mL)	368.5 (224.8-526.4)	312.6 (188.4-468.2)	458.3 (316.8-624.6)	0.002
Infected necrosis at drainage	48 (35.8)	18 (22.0)	30 (57.7)	< 0.001

APACHE: Acute Physiology and Chronic Health Evaluation; CRP: C-reactive protein; CTSI: Computed tomography severity index.

Table 2 Univariate analysis of prognostic factors, n (%)

Variable	Good prognosis (n = 82)	Poor prognosis (n = 52)	OR (95%CI)	P value
Age ≥ 55 years	26 (31.7)	28 (53.8)	2.51 (1.23-5.12)	0.011
APACHE II score ≥ 17	22 (26.8)	38 (73.1)	7.48 (3.41-16.38)	< 0.001
CTSI ≥ 8	24 (29.3)	36 (69.2)	5.38 (2.52-11.48)	< 0.001
CRP ≥ 300 mg/L at drainage	26 (31.7)	36 (69.2)	4.82 (2.28-10.19)	< 0.001
Infected necrosis confirmed	18 (22.0)	30 (57.7)	4.73 (2.19-10.21)	< 0.001
Drainage timing > 72 hours from diagnosis	28 (34.1)	36 (69.2)	4.34 (2.03-9.27)	< 0.001
Organ failure ≥ 2 systems	14 (17.1)	30 (57.7)	6.54 (2.93-14.60)	< 0.001
Catheter size < 14 Fr	22 (26.8)	26 (50.0)	2.73 (1.30-5.74)	0.008
Collection volume ≥ 400 mL	22 (26.8)	30 (57.7)	3.68 (1.73-7.82)	< 0.001
Walled-off necrosis type	30 (36.6)	32 (61.5)	2.76 (1.34-5.70)	0.006
Serum albumin < 30 g/L	18 (22.0)	26 (50.0)	3.49 (1.62-7.53)	0.001

Variables with P < 0.10 in univariate analysis were included in multivariate logistic regression. OR: Odds ratio; CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation; CRP: C-reactive protein; CTSI: Computed tomography severity index.

Table 3 Multivariate logistic regression analysis of independent prognostic factors

Independent variable	Adjusted OR	95%CI	P value
APACHE II score ≥ 17	5.82	2.38-14.22	< 0.001
Infected necrosis confirmed	4.16	1.76-9.84	0.001
Drainage timing > 72 hours from diagnosis	3.74	1.58-8.86	0.003
CTSI ≥ 8	3.28	1.38-7.80	0.007
Organ failure ≥ 2 systems	3.06	1.23-7.62	0.016
CRP ≥ 300 mg/L at drainage	2.89	1.18-7.07	0.020
Collection volume ≥ 400 mL	2.54	1.06-6.08	0.036
Serum albumin < 30 g/L	2.38	1.01-5.62	0.048

Area under the curve of multivariate model = 0.892 (95% confidence interval: 0.837-0.947); Hosmer-Lemeshow goodness-of-fit P = 0.418. OR: Odds ratio; CI: Confidence interval; APACHE: Acute Physiology and Chronic Health Evaluation; CRP: C-reactive protein; CTSI: Computed tomography severity index.

Table 4 Clinical outcomes stratified by drainage timing, n (%)/median (interquartile range)

Outcome	Early drainage ≤ 72 hours (n = 70)	Late drainage > 72 hours (n = 64)	OR/difference	P value
Clinical success rate	58 (82.9)	38 (59.4)	3.32 (1.47-7.50)	0.004
ICU stay (days)	8.4 (5.2-12.6)	14.8 (9.6-22.4)	-6.4	< 0.001
Total hospital stay (days)	24.6 (18.4-32.8)	36.8 (28.6-48.4)	-12.2	< 0.001
Organ failure resolution at 7 days	44 (62.9)	24 (37.5)	2.82 (1.38-5.76)	0.004
Need for additional drainage	14 (20.0)	26 (40.6)	0.37 (0.17-0.81)	0.013
Progression to surgical intervention	6 (8.6)	18 (28.1)	0.24 (0.09-0.67)	0.006
In-hospital mortality	4 (5.7)	14 (21.9)	0.22 (0.07-0.71)	0.011

Early drainage: ≤ 72 hours from diagnosis to first percutaneous drainage. Late drainage: > 72 hours from diagnosis. OR: Odds ratio; ICU: Intensive care unit.

Table 5 Clinical outcomes stratified by fluid collection type, n (%)/median (interquartile range)

Outcome parameter	APFC/pseudocyst (n = 58)	WON (n = 76)	OR/difference	P value
Clinical success rate	52 (89.7)	44 (57.9)	5.82 (2.11-16.06)	< 0.001
Days to clinical improvement	5.2 (3.8-7.4)	9.8 (6.4-14.6)	-4.6	< 0.001
Catheter dwell time (days)	8.4 (5.6-12.8)	18.6 (12.4-26.8)	-10.2	< 0.001
Catheter blockage requiring exchange	4 (6.9)	22 (28.9)	0.19 (0.06-0.59)	0.001
Secondary infection	6 (10.3)	22 (28.9)	0.28 (0.10-0.77)	0.008
Need for necrosectomy	2 (3.4)	20 (26.3)	0.10 (0.02-0.45)	< 0.001
In-hospital mortality	2 (3.4)	16 (21.1)	0.13 (0.03-0.61)	0.003

APFC: Acute peripancreatic fluid collection; WON: Walled-off necrosis; OR: Odds ratio.

Table 6 Drainage-related complications and procedural outcomes (n = 134)

Complication/outcome	n (%)	Management	Resolution rate
Catheter dislodgement	12 (8.9)	Re-insertion	11/12 (91.7%)
Catheter blockage	26 (19.4)	Flushing/exchange	24/26 (92.3%)
Bleeding at puncture site	8 (6.0)	Conservative/TAE	8/8 (100%)
Secondary infection	28 (20.9)	Antibiotics adjustment	22/28 (78.6%)
Pancreatic fistula	16 (11.9)	Conservative	13/16 (81.3%)
Colonic fistula	4 (3.0)	Surgical repair	3/4 (75.0%)
Overall complication rate	58 (43.3)	-	-
Overall clinical success rate	96 (71.6)	-	-
In-hospital mortality	18 (13.4)	-	-

Clinical success defined as collection resolution without need for emergency surgical intervention or in-hospital mortality attributable to peripancreatic fluid collections-related complications. TAE: Transcatheter arterial embolization.