Analysis Of Risk Factors For The Outcome Of Local Complications Of Acute Pancreatitis

Objective To analyze the clinical features of acute pancreatitis with local complications,explore potential risk factors for the outcome of local complications,and provide guidance for the intervention and treatment of loeal complications of acute pancreatitis.Methods A retrospective analysis of patients diagnosed of acute pancreatitis with local complications hospitalized to the First Affiliated Hospital of Soochow University from January 2013 to December 2017 was performed.The physiological and clinical parameters,imaging examinations,organ failures,interventions and outcomes were recorded.Clinical features of acute interstitial edematous pancreatitis(IEP)and acute necrotizing pancreatitis(ANP)were compared.Comparing patients with pancreatic pseudocyst(PP)versus without PP,patients with walled-off necrosis(WON)versus without WON to find potential risk factors.Comparing predictors of intervention and mortality.Results A total of 265 patients with local complications were enrolled in this study,who were mainly elderly,male and biliary pancreatitis.Respiratory failure was the most common organ failure among them.Renal and circulatory failure were common in patients with ANP compared to patients with IEP.The former had higher heartbeat and respiratory rate,higher APACHE ? and BISAP scores,higher levels of serum creatinine and Potassium,lower levels of PaCO2 and serum albumin,which led to longer hospital-stay and higher mortality.Of the 131 patients with APFC,34 developed PP,89 spontaneously resolved and 8 died.Of the 34 patients who developed PP,2 required intervention.Of the 134 patients with ANC,55 developed WON,58 had resolved collection,1 developed PP and 20 died.Of the 55 patients with WON,19 underwent intervention,33 were treated conservatively and 3 died.High CTSI score and wide distribution of APFC suggested high probability of PP formation,but not as separate risk factors.CTSI score?7,pancreatic necrosis area?30%,persistent organ failure and multiple organ dysfunction syndrome(MODS)suggested high possibility of WON formation,of which persistent organ failure was an independent risk factor.MODS and infection were independent risk factors for intervention.Age,pH,24-hour urine volume and MODS were independent risk factors for death.Conclusion Compared to patients with IEP,patients with ANP had worsen condition,longer hospital-stay and higher mortality.PP developed from APFC required fewer interventions and with which patients had fine prognosis.WON developed from ANC required various interventions and patients with which had high mortality.