Clinical Analysis Of Lung Injury Associated With Acute Severe Pancreatitis In The Elderly

AimsAcute pancreatitis(AP)is a common clinical disease.Most of AP cases are mild(Mild acute pancreatitis,MAP)and self-limited.A small proportion of AP patients are thought as severe acute pancreatitis(SAP),which is characterized by severe destruction of pancreatic tissue,multiple organ damage and high mortality.Among the multiple organ injuries caused by SAP,acute lung injury(ALI)and acute respiratory distress syndrome(ARDS)are the most prominent.SAP in the elderly is more complicated and has more complications,which makes it more difficult to judge and treat.Therefore,ALI/ARDS in the acute response period of elderly AP patients should be paid enough attention.The purpose of this retrospective study was to explore the risk factors and possible treatment strategies of ALI/ARDS in elderly patients during the acute phase of SAP.MethodsElderly AP patients(aged over 60 years)who were hospitalized in the First Affiliated Hospital of Soochow University from January 2014-January 2018 were enrolled in this study.Incomplete clinical data were excluded and finally 123 cases were collected for the purpose of this study.Another 93 patients(<60 years old)with complete data were served as controls.On the basis of data collection,we described and analyzed the general situation of SAP,etiology,occurrence of ALI/ARDS,results of laboratory and imaging examinations,and risk factors of ALI/ARDS.To compare the differences of different variables between the two groups(with or without lung injury),positive variables in univariate analysis were included in forward conditional stepwise logistic regression analysis.Receiver operating characteristic curve(ROC)was drawn and the area under curve(AUC)was calculated to analyze the predictors of SAP-related lung injury in the elderly.In order to explore possible treatment strategies of ALI/ARDS in elderly patients during the acute phase of SAP,the preventive effect of early use of ulinastatin and early enteral nutrition on SAP-related lung injury in the elderly was analyzed.Results123 elderly patients with SAP were enrolled in this study.Among them,36(29.27%)had ALI and 35(28.46%)had ARDS.There were 5 deaths(mortality 9.62%)in patients without ALI/ARDS and 17 deaths(mortality 29.06%)in patients with ALI/ARDS.There was no significant difference in mortality between young SAP patients with ALI/ARDS and elderly patients,but there was significant difference in etiological composition between the two groups.There was no significant difference between the ALI/ARDS group and the normal group in smoking and drinking rates.Comparing the collected laboratory test indicators,we found that there were significant differences in serum C-reactive protein between the elderly SAP group without ALI/ARDS,SAP group with ALI and SAP group with ARDS,while other laboratory indicators did not play a significant role in predicting and evaluating lung injury in elderly SAP.With the increase of APACHE Ⅱ score,BISAP score,Ranson score and CTSI score,SAP-related lung injury tended to aggravate.Logistic regression analysis showed that age,C-reactive protein,white blood cell count,APACHE II score and BISAP score were risk factors for ALI/ARDS in elderly SAP patients.The results of ROC curve analysis indicated that C-reactive protein,APACHE Ⅱ score,BISAP score and Ranson score were useful factors for predicting ALI/ARDS.The best cut-off values of C-reactive protein,APACHE Ⅱ score,BISAP score and Ranson score were 138.6 mg/L,9.5,3.5 and 2.5,respectively.Two comprehensive analysis results showed that C-reactive protein,APACHE Ⅱ score and BISAP score were both risk factors and predictors of ALI/ARDS in elderly SAP patients.Early use of ulinastatin and enteral nutrition can prevent SAP-related lung injury.Conclusions(1)The incidence of lung injury in elderly patients with SAP is less related to etiology,smoking and alcohol consumption.(2)C-reactive protein,APACHE Ⅱ score and BISAP score are both risk factors and predictors of ALI/ARDS in elderly SAP patients.(3)Early use of ulinastatin and enteral nutrition can prevent SAP-related ALI/ARDS in the elderly.