Infected pancreatic necrosis complicating severe acute pancreatitis in critically ill patients: predicting catheter drainage failure and need for necrosectomy

Garret, Charlotte; Douillard, Marion; David, Arthur; Péré, Morgane; Quenehervé, Lucille; Legros, Ludivine; Archambeaud, Isabelle; Douane, Frédéric; Lerhun, Marc; Regenet, Nicolas; Gournay, Jerome; Coron, Emmanuel; Frampas, Eric; Reignier, Jean

doi:10.1186/s13613-022-01039-z

Annals of Intensive Care

Table 1 Baseline characteristics and outcomes of the study patients

From: Infected pancreatic necrosis complicating severe acute pancreatitis in critically ill patients: predicting catheter drainage failure and need for necrosectomy

	Overall population n = 72	Drainage success n = 32	Drainage failure n = 40	P value
Baseline characteristics and CTSI
Age, y, mean (SD)	57 (149)	56 (16)	58 (14)	0.54
Males, n (%)	58 (80.6)	26 (81.3)	32 (80)	0.89
BMI, mean (SD)	27.94 (6.5)	25.83 (4.6)	29.65 (7.4)	0.02
Cause of pancreatitis, n (%)
Biliary	23 (31.9)	10 (31.2)	13 (32.5)	0.98
Alcohol abuse	25 (34.7)	12 (37.5)	13 (32.5)
Other^a	24 (33.3)	10 (31.2)	14 (35)
SOFA score^b, median [IQR]	3 [0–12]	2 [0–11]	3 [0–12]	0.39
CTSI, mean (SD)	7 (2)	6 (2)	7 (2)	0.07
Persistent organ failure^c after the first 48 h, n (%)
Respiratory failure	17 (23.9)	5 (15.6)	12 (30.8)	0.14
Hemodynamic failure	11 (15.5)	3 (9.4)	8 (20.5)	0.21
Renal failure	8 (11.1)	3 (9.4)	5 (12.5)	0.67
Organ failure^c within 24 h before catheter drainage, n (%)
Respiratory failure	29 (40.8)	7 (21.9)	22 (56.4)	0.004
Hemodynamic failure	15 (21.1)	5 (15.6)	10 (25.6)	0.3
Renal failure	9 (12.7)	3 (9.4)	6 (15.4)	0.45
Drainage modalities
Time from diagnosis to drainage (days), median [IQR]	21 [12–29]	18 [9–25]	24 [15–28]	0.06
Percutaneous catheter drainage n (%)	52 (72.2)	26 (81.2)	26 (65)	0.13
Endoscopic catheter drainage n (%)	20 (27.8)	6 (18.7)	14 (35.)	0.13
Antibiotic therapy before drainage n (%)	41 (60.3)	20 (64.5)	21 (56.7)	0.51
Time from antibiotic initiation to drainage (days), mean (SD)	7 (7)	9 (8)	5(5)	0.08
Second drainage (percutaneous or endoscopic)	41 (74.5)	19 (59.4)	22 (95.6)	0.01
Overall antibiotic duration during hospital stay (days), median [IQR]	47 [28–77]	38 [26–61]	50 [28–88]	0.17
Microbiological results, n (%)
Bacteremia	39 (54.2)	18 (56.2)	21 (52.5)	0.75
Fungal microorganism	13 (18.1)	5 (15.6)	8 (20.)	0.63
Multidrug- resistant bacterial microorganism	24 (33.3)	7 (21.9)	17 (42.5)	0.06
Complications of acute pancreatitis during ICU stay, n (%)
Bleeding	14 (19.4)	2 (6.2)	12 (30)	0.011
Perforation of hollow organ	8 (11.1)	0 (0)	8 (20)	0.007
Bowel ischemia	5 (6.9)	0 (0)	5 (12.50%)	0.06
Outcome
Hospital stay length (days), median [IQR]	70 [43–98]	53 [36–70]	88 [61–114]	0.001
Hospital mortality, n (%)	12 (16.7)	0 (0)	12 (30)	0.0007

CTSI computed tomography severity index, BMI body mass index; SOFA Sequential Organ Failure Assessment. Bold numbers indicate p<=0.05
^aHypertriglyceridemia, drugs, endoscopic retrograde cholangiopancreatography, trauma, unidentified
^bThe scale ranges from 0 to 24, with higher scores indicating greater severity of organ dysfunction
^cOrgan failure was defined as a SOFA subscore ≥ 2 for the respiratory, renal, and/or hemodynamic systems

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