Study Of Risk Factors For Secondary Infections In The Late-pahse Of Severe Acute Pancreatitis

BackgroundSevere Acute Pancreatitis(SAP)is a common clinical acute abdominal disease with the characters of nasty onset,fast condition changes and high case fatality.Generally,the disease progression can be divided into acute phase and convalescence phase with two peaks of mortality.Patients with SAP in acute phase often suffer from heavy Systemic Inflammatory Response Syndrome(SIRS)and even Multiple Organ Failure(MOF),which is the first leading cause of death in patients.In recent years,with the development of studies in SAP pathogenesis,pathophysiology,as well as the progress in clinical inspection technology and multidisciplinary collaborative treatment,most of the patients can be smoothly through the acute response phase into late-phase period.The secondary infections of pancreatic and peripancreatic necrosis is the most common complication of SAP patients in the recovery period with a high incidence of more than 1/3,which can further lead to sepsis or even MOF,being another major cause of mortality.Although series of clinical and basic studies related to it have been carried out,the exact inducement,risk factors,pathogenesis are still not clear.The infected pancreatic necrosis have been proved to be principal cause of SAP.It remains a hot and tough problem to reduce the occurrence of secondary infections in SAP and decrease the mortality.ObjectiveThe purpose of the investment is to identify the associated risk factors for the late-phase secondary infections of patients with SAP diagnosed at Qilu Hospital of Shandong University through retrospect analysis of clinical data.So that we can provide scientific and useful reference for clinical diagnosis and treatments.Methods1.Data selection:Complete clinical data of 144 cases diagnosed of SAP in Qilu Hospital of Shandong University from January 1,2012 to January 1,2017 were collected.The diagnosis and classification of severity standard refers to Practice guidelines for the diagnosis and treatments in acute pancreatitis of China(2013,Shanghai).Patients were divided into two groups according to whether suffering from a secondary infection or not.The data collected includes gender,age,BMI,APACHE-II scores,JSS scores,anamneses,biochemical examinations,days of intestinal dysfunction,fasting time duration,days of mechanical ventilation,days of CRRT,local and systemic complications,treatments and so on.2.Data processing:In this study the statistical analysis of the whole data is by Excel 2007 and SPSS 19.0 software.Measurement data is recorded with mean ±standard deviation(x+s),those conforming to normal distribution using t test and the rest using Mann-Whitney U-test when compared between two groups and count data by chi-square test.P<0.05 is considered statistically significant.Then we chose the statistically different factors as independent variables applying logistic regression analysis to explore the independent risk factors for SAP secondary infection.Results1.144 patients of whose whole clinical data were involved in the study with 85male and 59 female.The incidence of secondary infections and mortality of the overall were 31.9%and 18.7%respectively and the mortality of infectious group were 34.1%particularly.2.The APACHE-II scores,JSS scores,CRP,ratio of neutrophils,blood calcium,LDH,ALB,SAP patients with respiratory failure and IAH,bowel dysfunction,mechanical ventilation rate were considered statistically significant different in two groups.(p<0.05)3.Multivariable logistic regression analysis imply that the JSS scores(OR=3.580,p=0.039),bowel dysfunction days(OR = 2.064,p=0.004)and CRP(OR=1.020,p=0.018)are positively related to the incidence of infected pancreatic necrosis,while blood calcium(OR=0.002,p=0.006)is negatively related to it.All of the above are independent risk factors for SAP late-phase secondary infections.ConclusionsThe JSS scores,bowel dysfunction days,blood calcium and CRP are considered as independent risk factors for SAP late-phase secondary infections.As a result,it may be effective ways by closely supervising and improving the aforementioned several index changes in order to prevent late-phase secondary infections and reduce the mortality of SAP patients.