The Study About Effects Of Abdominal Paracentesis Drainage In Patients With Severe Acute Pancreatitis-Associated Liver Injury

Objective: To systematically evaluate the efficacy and safety of early abdominal paracentesis drainage(APD)in patients with severe acute pancreatitis(SAP),and determine the protective effects of APD on pancreatitis-associated liver injury in the early phase of SAP.Part Ⅰ: Efficacy and safety of early abdominal paracentesis drainage on patients with severe acute pancreatitis: a meta-analysisMethods: Chinese and English databases such as Pub Med,Cochrane Library,Web of Science,CNKI,Wanfang Data,and VIP were searched to include randomized controlled trials(RCT)and cohort studies on the management of SAP via early APD from inception to December 30,2022.Results: Eighteen studies were included with a total sample size of 2685 patients.The meta-analysis showed that early APD could decrease mortality(OR=0.49,95%CI=0.35～0.69,P<0.001)and the incidences of multiple organ failure(OR=0.56,95%CI=0.45～0.71,P < 0.001),ARDS(OR=0.54,95%CI=0.41～0.71,P < 0.001)and infection complication(OR=0.72,95%CI=0.57～0.92,P=0.009),and also reduce the need for further interventions(OR=0.54,95%CI=0.42～0.69,P < 0.001)and the total cost during hospitalization(SMD=-1.10,95%CI=-1.56～-0.64,P<0.001),reduce the length of stay(MD=-5.65,95%CI=-8.96～-2.34,P<0.001)and reduce days in intensive care unit(ICU)(MD=-1.32,95%CI=-2.28～-0.36,P=0.007).However,there were no significant differences in the incidence of pneumonia(OR=0.69,95%CI=0.44～1.07,P=0.10),bacteremia(OR=0.92,95%CI=0.67～1.26,P=0.60)and sepsis(OR=0.78,95%CI=0.53～1.16,P=0.22)between the two groups.Conclusion: The treatment of SAP via early APD,which has a high clinical value,could decrease the incidence of multiple organ failure,improve the prognosis of patients and reduce the associated mortality rate.Moreover,APD does not increase the risk of infection-related complications.Due to the limited quantity and quality of included studies,more high-quality studies are needed to verify the above conclusion.Part Ⅱ: The protective effects of abdominal paracentesis drainage in patients with severe acute pancreatitis-associated liver injury: a retrospective studyMethods: One hundred and fourteen consecutive patients with SAP,admitted to our hospital from January 2015 to January 2021,were included in this retrospective study.The patients were divided into the APD group(n=61)and the non-APD group(n=53)based on whether they underwent APD treatment within 72 hours of admission.The variables including baseline data,liver function tests,inflammation indexes,severity scores and other variables were statistically analyzed.Results: The hospital mortality in APD group was lower than that in NonAPD group(8.2% vs.22.6%,P=0.031).These severity scores(including APACHE II score,Ranson score and modified Marshall score)and inflammation indexes(including the levels of CRP、IL-6、IL-1 and TNF-α)in APD group were all lower than those in Non-APD group(P<0.05).In terms of liver function related indexes,the levels of GGT,ALT,AST,TBIL and DBIL in both groups were significantly lower than those before treatment.The levels of ALT、AST、TBIL and DBIL after treatment in APD group were lower than those in Non-APD group,and the levels of PA and ALB after treatment in APD group were higher than those in Non-APD group(P < 0.05),but there were no significant differences in the levels of ALP、GGT and 5’-NT after treatment in the two group(P>0.05).Conclusion: For SAP patients with ascitic fluid,application of APD can attenuate liver injury and improve liver function in the early stage of SAP.