Risk Factors Of Infected Pancreatic Necrosis Secondary To Severe Acute Pancreatitis:the Role Of Early Contrast-enhanced CT

Background:Pancreatic necrosis is a risk factor for poor prognosis of acute pancreatitis(AP).However,the associations between early contrast-enhanced computed tomography(CT)imaging of the pancreas and infected pancreatic necrosis(IPN)are unclear.Objective:The study aimed to analysis the associations between early contrast-enhanced CT imaging of the pancreas and IPN secondary to severe acute pancreatitis(SAP),and study the risk factors of IPN secondary to SAP.Methods:This was a retrospective study.Patients with SAP from January 2014 to December 2016 at the First Affiliated Hospital of Nanchang University were enrolled and assigned to an IPN group and a non-IPN group.Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and IPN development.A receiver operating characteristic(ROC)curve was generated for the qualified independent risk factor.Results:Forty-two patients with IPN were compared with 100 patients without IPN.The average age of all patients was 55.87±15.47 years(range 19 to 84 years),and the study included 74 males(52.11%).Multivariate stepwise logistic regression analyses showed that the number of acute peripancreatic fluid collections(OR: 1.335,95%CI:1.09-1.635,p<0.01),presence of pancreatic parenchymal necrosis or peripancreatic and pancreatic parenchymal necrosis(OR: 3.763,95%CI: 1.618-8.753,p<0.01)and intestinal wall thickening(OR: 3.387,95%CI: 1.436-7.992,p < 0.01)were independent risk factors of IPN secondary to SAP.The area under an ROC curve for the number of APFCs was 0.714,the sensitivity was 78.60%,and the specificity was 57.30% at a cut-off value of 4.5.Conclusions:The number of APFCs,presence of pancreatic parenchymal necrosis or peripancreatic and pancreatic parenchymal necrosis,and gastrointestinal wall thickening were independent risk factors associated with IPN.As early contrast-enhanced CT plays an important role in predicting IPN,it is important for clinicians to consider early imaging of the pancreas.