Clinical Study On Risk Factors Of Death And Secondary Infections In Patients With Severe Acute Pancreatitis

BackgroundDeveloping secondary pancreatic(peripancreatic)or systemic infections in patients with severe acute pancreatitis(SAP)will have a higher mortality.Accorrding to some related risk factors to identify high-risk patients earlier and accureately is very important to reduce mortality.At present,there is no consistency in relevant risk factors about secondary pancreatic(peripancreatic)or systemic infections in SAP patients in the published literatures.ObjectiveTo explore the risk factors of death and secondary infection in patients with severe acute pancreatitis,which is conducive to evaluate risk stratification and prognosis of acute pancreatitis(AP)patients earlier and accureately,so as to improve the cure rate and reduce the mortality.Materials and MethodsThe study comprised 89 patients with SAP who were admitted to Qilu Hospital of Shandong University from January 1,2016 to December 31,2018.All the patients were divided into the survival and death group(71 vs 18 patients)according to clinical outcomes.Meanwhile,the 89 patients were divided into non-secondary and secondary infection group(41 vs 48 patients),according to whether suffering from pancreatic,peripancreatic or systemic infections.The clinical data included general data,etiology,symptoms,laboratory examinations,local and systemic complications,BISAP score,Ranson's score,APACHE ? score,MCTSI score,and basic diseases(hypertension,coronary atherosclerotic heart disease,diabetes or fatty liver).The collected data were compared between the survival and death groups,non-secondary and secondary infection groups.Univerite and multivariate Logistic regression analysis were performed to analyze the independent risk factors of death and secondary infection in SAP patients.ResultsAmong the 89 SAP patients,the overall mortality and incidence of secondary infection was 20.22%and 53.93%respectively.The mortality in secondary and non-secondary infection group were 31.25%and 7.32%(P=0.005).Multivariate Logistic regression analysis suggested that lactate dehydrogenase(OR=1.003,95%CI:1.001-1.004,P=0.002),lactic acid(OR=2.613,95%CI:1.397-4.886,P=0.003),and paralytic ileus(OR=11.334,95%CI:1.972-65.261,P=0.007)were independent risk factors of death in SAP patients,and these factors were positively correlated with death.Albumin(OR=0.765,95%CI:0.607-0.964,P=0.023)was negatively correlated to the incidence of secondary infection in SAP patients,while acute necrotic collection(OR=17.675,95%CI:1.334-326.334,P=0.030)and paralytic ileus(OR=17.675,95%CI:1.144-272.960,P=0.040)were positively correlated to it.All of above were independent risk factors of secondary infection in SAP patients.Conclusions(1)Lactate dehydrogenase,lactic acid and paralytic ileus were independent risk factors,positively correlated with death in SAP patients.(2)Secondary infection increases mortality in patients with SAP.Albumin was negatively correlated to the incidence of secondary infection in SAP patients,while acute necrotic collection and paralytic ileus were positively correlated to it.All of above were independent risk factors of secondary infection in SAP patients.(3)Paralytic ileus may be one of the important references for secondary infection in SAP patients.When paralytic ileus occurs in SAP patients,it is necessary to alert to the occurrence of secondary infection.