Analysis For The Risk Factors Of Early Death For The Severe Acute Pancreatitis Patients

BackgroundSevere acute pancreatitis(SAP)severe abdominal emergency with onset urgently,rapid progression,complex condition,multiple complications and high mortality,which require close clinical monitoring,timely and urgent effective treatment.In recent 20 years,with the deepening of the understanding of SAP pathophysiology progress and the continuous progress of clinical treatment,the mortality of SAP has decreased significantly,but it is still as high as 36%-50%.There are two peaks in patient mortality,early disease(Within two weeks of onset)and later.(Four weeks after the onset of the disease),Especially the early death is the most common.Therefore,find a method of judging the disease in early clinical,accurately predict the prognosis and quantify the severity of the disease in the early clinical stage is helpful to guide the clinical selection of treatment plan scientifically,reduce the fatality rate and improve the prognosis.In this paper,The clinical features and biological parameters of 80 patients with SAP were analyzed retrospectively to explore the related factors that may be associated with the death of SAP patients and to discuss the parameters that can predict the prognosis of SAP.PurposeWe retrospectively analyzed and summarized the clinical and laboratory data of 80 patients with SAP admitted in the first affiliated Hospital of Da Lian Medical University in recent eight years.The relevant factors related to the prognosis were found out by statistical method in order to predict the prognosis of the patients,improvethe treatment method and improve the clinical effect and prognosis of the patients.Objects and MethodsA retrospective analysis of 122 cases with SAP admitted in the departments of the first affiliated Hospital of Da Lian Medical University in the past 8 years,according to the inclusion and exclusion criteria,80 cases SAP were screened out,(including 25 deaths,15 early deaths).Collating data include:(1)etiology;(2)general condition:age,gender,BMI,mortalit y,APACHE II score within 48 hours of admission;(3)indicators of pancreatic inj ury index:Rason score within 48 h hours of admission,Balthazar CT injury sever ity score within 72 hours,the blood amylase,the blood lipase;(4)indicators of the important organ or system dysfunction:(1)liver function index:albumin,alanine a minotrans-ferase,prothrombin time;(2)renal function index:serum creatinine,blood u rea nitrogen;(3)respiratory index:arterial oxygen partial pressure,arterial blood ca rbon dioxide partial pressure,PH value,whether pleural effusion or not,alkali res idue(within 24 h admission and 5 consecutive days);(5)metabolism and infection index :blood calcium,blood sugar,leukocyte;(6)systemic complications:whether with shock or not,whether with ascites or not;(7)number of early complicated organ f ailure,and to explore the risk factors related to death.All the required test indexe s were collected in 24h-48 h after admission,except for BE.All the patients enroll ed in the study were hospitalized in the initial 24 h,which were all in line witht he diagnosis and classification criteria for the diagnosis and treatment of pancrea titis in the 2014 edition of China.Results1.Among the 80 patients with severe acute pancreatitis(SAP)patients,of which25 cases died in the duration of hospital stay,the mortality rate was 31.25%,and 15 cases with early death accounted for 60% of the total deaths.Among the early dead patients,13 were male,accounting for 86.67% of the total.2.The onset age of patients with SAP is 22~89 years old,with an average age of53.3±17years.The hospitalization date is 1~84 days,and the average hospitalization date is 20±17.69 days.Among the etiological factors,26 cases were biliary origin,accounting for 32.25%,10 cases were overeating and drinking,the proportion was12.5%,alcohol accounted for 17 cases,the proportion was 21.25%,hyperlipidemia accounted for 12 cases,the proportion was 15%,idiopathic accounted for 15 cases,the ratio was 18.75%.It can be seen that biliary origin pancreatitis is the main cause of severe acute pancreatitis in our hospital.In addition,among the 15 early death patients with SAP,7 cases were biliary origin,accounting for 46.67%,alcohol accounted for 5cases,the proportion was 33.33%,idiopathic accounted for 3 cases,the ratio was 20%.3.80 Patients with severe acute pancreatitis were divided into early survival group(n = 65)and early death group(n = 15).The clinical data of the two groups were statistically analyzed as follows:3.1 Single variable factors analysis results shows that: there was no significant difference in age,body mass index,blood amylase,blood lipase,serum albumin,alanine aminotrans ferase(ALT),prothrombin time(PT),arterial blood oxygen Partial pressure(PaO2),arterial blood carbon dioxide partial pressure(PaCO2),PH value,leukocyte count(WBC),early complicated with ascites(P>0.05).There was significant difference in gender,etiological composition,creatinine,residual alkali(BE),blood urea nitrogen(BUN),serum calcium level,blood glucose level,APACHE II score,CTSI score,Rason score,serum calcium level,blood glucose level,combined pleural effusion,early combined shock and early integration of multiple organ dysfunction syndrome(MODS)(P<0.05).3.2 Binary logistic regression analysis showed that: BE,combine with shock in the early time,and early integration of MODS were independent risk factors for the prognosis of patients.3.3 The results of continuous observation for the first 5 days after admission showed that the base residual value of the early death group was significantly lower than that of the early survival group on the first days,and the base residual value of the two groups decreased slightly on the second days,beginning on the third day.In theearly survival group,the base residual value gradually returned to the normal level,and the change of be value in the early death group showed a general downward trend.The difference between the two groups is statistically significant(P<0.05).4.The majority of deaths in this group occurred in the early stages of the disease(<2 Weeks).In clinic,we should pay special attention to the support therapy of early important organ function and avoid the occurrence of MODS,which is the key to reduce the fatality rate.Conclusion1.gender,etiological composition,creatinine,residual alkali(BE),blood urea nitrogen(BUN),APACHE II score,CTSI score,Rason score,serum calcium level,blood glucose level,combined pleural effusion,early combined shock and early integration of multiple organ dysfunction syndrome(MODS)is a risk factor for severe acute pancreatitis.BE,early combined with shock,and early integration of MODS were independent risk factors for the prognosis of patients.2.The progressive decrease of BE value in early stage is significant in predicting early death in SAP patients.