| Objective:This article explored the influencing factors of acute pancreatitis(AP)complicated by pleural effusion(PE)and its prognosis.Methods:Retrospecting study January 2013-December 2017 The First Affiliated Hospital of Kunming Medical University,Department of Gastroenterology,AP patients with chest imaging examination.According to whether pleural effusion occurred,it was divided into two groups:pleural effusion group and no pleural effusion group.The pleural effusion group and the no pleural effusion group were divided into two subgroups according to length of stay:hospitalization time ≤ 7 days and hospitalization time>7 days.Two sets of general data,laboratory test results,and various scoring systems were compared and multi-factor regression analysis was performed on statistically significant indicators.investigating the influencing factors of AP complicated by pleural effusion and its prognosis.Results:1 General information1.1The incidence of pleural effusion A total of 326 patients with AP were included,pleural effusion 137 cases(42.02%),189 cases of non-pleural effusion(57.98%).1.2 gender Female patients were prone to pleural effusions.54(39.42%)women in the pleural effusion group were higher than 49(25.93%)patients without pleural effusion,and the difference was statistically significant(P<0.05 or P<0.01).1.3 age Pleural effusion group age 45.93±13.29(years)compared with no pleural effusion group age 44.28±15.39(years),there was no statistically significant difference(P>0.05).1.4 BMI The pleural effusion group BMI 24.46±3.60(kg/m2)was not significantly different from the without pleural effusion group BMI 24.84±3.21(kg/m2)(P>0.05).1.5 Past history No previous history of pancreatitis was prone to pleural effusion.In the pleural effusion group,103 cases(75.18%)had no previous history of pancreatitis,which were higher than 122 cases(64.55%)in non-pleural effusion group.The difference was statistically significant(P<0.05 or P<0.01).The previous history of non-smoking(58.40%)and non-drinking history(70.07%)was higher than that of the non-pleural effusion group(53.44%,66.67%),but the difference was not statistically significant(P>0.05).1.6 Causes In the pleural effusion group,biliary tract disease(24.82%),alcoholism(24.82%),and hyperlipidemia(8.76%)were higher than those without pleural effusion(19.05%,22.75%,7.94%),and dietary factors(23.36%)was lower than the non-pleural effusion group(29.63%).there were not significant difference(P>0.05).1.7 Hospital stay The length of hospital stay in the pleural effusion group was 11.43±4.49(days)higher than that of the no pleural effusion group(8.26±3.46(days)),which was significantly different(P<0.05 or P<0.01).Pleural effusions hospitalization≤7 days in 24 patients(17.51%),hospital stay>7 days 113 cases(82.48%).Without Pleural effusions hospitalization<7 days in 90 patients(47.62%),hospital stay>7 days 99 cases(52.38%).1.8 Hospital costs The cost of hospitalization in the pleural effusion group was 20681.79(14663.21,27202.69)(yuan)higher than that of the non-pleural effusion group 12991.38(9097.81,17827.18)(yuan),with statistical significance(P<0.05 or P<0.01).2 Pleural effusion distributionThe occurrence of pleural effusion in AP patients was mainly bilateral and a small amount of pleural effusion.Bilateral pleural effusion was found in up to 113 cases(82.48%),with 21 cases of left pleural effusion(15.33%)and right pleural effusion in 3 cases(2.19%).In the degree of pleural effusion,129 cases(94.16%)had a small amount of effusion,7 cases(5.11%)had moderate effusion,and 1 case(0.73%)had a large amount of effusion.3 Pleural effusion correlates with severity of APThe incidence of pleural effusion in patients with severe acute pancreatitis(SAP)was 72.82%.The pleural effusion group was prone to develop into SAP,and the incidence of complications was higher than that of the group without pleural effusion.The difference was statistically significant(P<0.05 or P<0.01).In the pleural effusion group,there were 31 cases(22.63%)of mild acute pancreatitis(MAP),31 cases(22.63%)of moderately severe acute pancreatitis(MSAP),and 75 cases(54.74%)of SAP.In the non-pleural effusion group,there were 107 cases(56.61%)of MAP,54 cases(28.58%)of MSAP,and 28 cases(14.81%)of SAP.Pleural effusions of patients with complications in 134 cases(97.81%)were higher than the non pleural effusions 162 cases(85.71%).4 Comparison of laboratory examination dataUnivariate analysis revealed that albumin,serum calcium,serum amylase,and lipase were lower in the pleural effusion group than in the group without pleural effusion.white blood cells,neutrophils,fibrinogen,and C-reactive protein in the pleural effusion group were higher than non-pleural effusion group,statistically significant(P<0.05 or P<0.01).The pleural effusion group blood glucose was higher than the no pleural effusion group,and blood urea nitrogen was lower than that of the no pleural effusion group,but there were not statistical difference(P>0.05).5 Comparison of different scoring systemsThe 48-hour Ranson score,MCTSI score,and BISAP score in the pleural effusion group were significantly higher than those in the non-pleural effusion group(P<0.05 or P<0.01).6 Independent risk factors of AP complicated pleural effusionMultivariate logistic analysis showed that there was no previous history of pancreatitis(OR=46.909,95%CI=2.630～76.664,P=0.009),fibrinogen(OR=3.138,95%CI=1.346～7.316,P=0.008),albumin(OR=2.176,95%CI=1.853～2.567,P<0.001),CRP(OR=1.656,95%CI=1.379～1.992,P<0.001),MCTSI score(OR=24.396,95%CI=4.868-52.256,P<0.001)and BISAP score(OR=103.285,95%CI=29.170-256.019,P<0.001)were independent risk factors for pleural effusion in acute pancreatitis.7 Factors affecting hospitalization time of AP patients with pleural effusionUnivariate analysis found that the hospitalization time>7 days group albumin and serum calcium were lower than the hospitalization time≤7 days group,while the blood glucose and 48 hours Ranson score were higher than the hospitalization time<7 days group,there was statistical significance(P<0.05 or P<0.01).8 Influencing factors of hospitalization time in AP patients without pleural effusionThe univariate analysis found that the CRP and MCTSI scores in the hospital stay>7 days group were significantly higher than the hospitalization time ≤7 days group(P<0.05 or P<0.01).Conclusions:1.The incidence of pleural effusion in patients with SAP was 72.82%.AP concurrent pleural effusion easily developed into SAP.The incidence of complications in patients with pleural effusion was 97.81%.Pleural effusion was closely related to the severity of the AP.2.Patients with AP complicated by pleural effusion were associated with patients with uncomplicated pleural effusions in terms of gender,serum calcium,serum amylase,lipase,leukocyte,neutrophil percentage,48-hour Ranson score,length of stay,and hospitalization costs.There were significant differences.3.The occurrence of pleural effusion in patients with AP were not significantly correlated with age,BMI,cause of onset,smoking history,and drinking history.4.There was no previous history of pancreatitis,fibrinogen,albumin,CRP,MCTSI score,and BISAP score were independent risk factors of AP complicated by pleural effusion.5.Albumin,serum calcium,blood glucose,and Ranson score were the influencing factors of hospitalization time for AP patients with pleural effusion.6.The CRP and MCTSI scores were the influencing factors of the hospitalization time of AP patients without pleural effusion.7.Patients admitted to the hospital should routinely improve chest imaging examination and dynamically review if necessary.Early intervention can be made for controllable factors in patients.reducing the probability of developing MSAP or SAP and reducing hospital stay,improving the prognosis. |
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