Risk Factors Of Infected Pancreatic Necrosis With Severe Acute Pancreatitis

Objective: To evaluate the value of relevant serological indicators in predicting infective pancreatic necrosis complicated with severe acute pancreatitis,and to construct a combined prediction model with multiple indicators,so as to provide reference for early clinical intervention to reduce the occurrence of infective pancreatic necrosis and reduce the mortality of patients with severe acute pancreatitis.Methods:Collected and analyzed the Second Hospital of Hebei Medical University between January 2017 and December 2019,a total of 103 patients with diagnosis of the basic information of the hospitalized patients with SAP(age,gender,pathogeny),blood routine examination,biochemical criterion,PCT,CRP,D-dimer.Patients were divided into the infected pancreatic necrosis group and the non-infected pancreatic necrosis group according to the presence or absence of pancreatic infection,and the statistical analysis was conducted by SPSS 25.0 software.The shapiro-wilkmethod was used to test the normality of the measurement data.The independent sample t test was used for the comparison between the two groups.The data conforming to the normal distribution were expressed as mean ± standard deviation((?)±S).Data that did not conform to normal distribution were represented by median(inter-quartile range),and mann-whitney U test was used for comparison between the two groups.The rate of use(composition ratio)of enumeration data indicated that Pearson chi-square or Fisher’s exact probability method was used for comparison between the two groups.Variables with statistical differences were analyzed by binary multivariate Logistic stepwise regression to identify independent risk factors,and odds ratio(OR)and 95% confidence interval were calculated to identify independent risk factors.The selected independent risk factors using the ROC curve to calculate the area under the curve(AUC),sensitivity,specificity and youden index.The largest youden index is cutoff value.P<0.05 was statistically significant.Results:1.A total of 103 SAP patients were included in this study,including 39 in the infected group(37.9%)and 64 in the non-infected group(62.1%).The incidence of infected pancreatic necrosis was 37.9%.2.The results of single factor analysis show that:c-reactive protein(CRP)(P=0.02),procalcitonin(PCT)(P=0.000),D-dimer(P=0.000),UREA(P=0.034),CREA(P=0.003),β2-MG(P=0.004)the infected group was higher than the non-infected group,there was a statistical difference between the two groups.3.The factors with statistical differences in univariate analysis were used as independent variables,and the secondary pancreatic infection was used as dependent variables for multivariate Logistic stepwise regression analysis.The results showed that PCT(OR=1.253,P=0.005)were independent risk factors for infected pancreatic necrosis secondary to SAP.4.The continuous variables PCT with statistical significance were used to plot the ROC curve.The results showed that The AUC value of PCT was0.643,the cutoff value was 5.77ng/ml,the sensitivity was 54.5%,the specificity was 70.8%,and the youden index was 0.253.Conclusions:1.PCT,CRP,D-Dimer,UREA,CREA and β2-MG were different between the group with and without infective pancreatic necrosis.2.PCT were considered as independent risk factors for infected pancreatic necrosis secondary to SAP.Monitoring the changes and early intervention during the hospitalization of SAP patients is helpful to prevent the occurrence of infected pancreatic necrosis secondary to SAP and improve the prognosis of patients.