RESUMEN
BACKGROUND: The objective of this study is to develop and validate a new nomogram-based scoring system for anticipating the recurrence of acute pancreatitis (AP) in combined hypertriglyceridemia (HTG). METHODS: A total of 292 patients diagnosed with AP combined with HTG participated in this research. Among them, 201 patients meeting the inclusion criteria were randomly divided into training and validation sets at a ratio of 7:3. Clinical data were collected for all patients. In the training set, predictive indicators were chosen through backward stepwise multivariable logistic regression analysis. Subsequently, a nomogram was developed based on the selected indicators. Finally, the model's performance was validated in both the training and validation sets. RESULTS: By employing backward stepwise multivariable logistic regression analysis, we identified diabetes, gallstones, alcohol consumption, and triglyceride levels as predictive indicators. Subsequently, a clinical nomogram that incorporates these four independent risk factors was constructed. Model validation demonstrated an AUC of 0.726 (95% CI 0.644-0.809) in the training set and an AUC of 0.712 (95% CI 0.583-0.842) in the validation set, indicating a good discriminative ability. The Hosmer-Lemeshow test yielded P-values of 0.882 and 0.536 in the training and validation sets, respectively, suggesting good calibration. Calibration curves further confirmed good agreement. Ultimately, decision curve analysis (DCA) emphasized the clinical utility of our model. CONCLUSION: We have developed a nomogram for predicting the recurrence of AP combined with HTG in patients, and this nomogram demonstrates good discriminative ability, calibration, and clinical utility. This tool holds the potential to assist clinicians in offering more personalized treatment strategies for AP combined with HTG.
Asunto(s)
Hipertrigliceridemia , Nomogramas , Pancreatitis , Recurrencia , Humanos , Hipertrigliceridemia/diagnóstico , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/sangre , Pancreatitis/diagnóstico , Pancreatitis/sangre , Masculino , Femenino , Persona de Mediana Edad , Adulto , Factores de Riesgo , Medición de Riesgo/métodos , Triglicéridos/sangre , Enfermedad Aguda , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Cálculos Biliares/complicaciones , Cálculos Biliares/diagnósticoRESUMEN
Acute pancreatitis (AP) is a complex and unpredictable condition, of which hypertriglyceridemia (HTG) is the third most prevalent cause. This study aimed to conduct a retrospective analysis of clinical data from hospitalized AP patients to uncover a potential correlation between triglyceride (TG) levels and the necessity for intensive care unit (ICU) admission. This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV) critical care dataset, incorporating data from 698 patients with hypertriglyceridemic acute pancreatitis (HTG-AP). The analysis employed the RCS model along with univariate and multivariate logistic regression methods to affirm the association between triglyceride levels and ICU admission. Subgroup analysis was performed to investigate specific populations. The study included 698 patients with AP, 42.41% of whom experienced HTG during hospitalization. RCS analysis revealed a linear association between TG levels and risk of ICU admission (p for nonlinearâ =â .219, p for overallâ =â .009). Multivariate logistic regression analysis indicated an increased risk of ICU admission in the TG range of 1.7-5.65 mmol/L (aORâ =â 1.83, 95% CI 1.12-2.99, Pâ =â .015) and TG >11.3 mmol/L (aORâ =â 5.69, 95% CI 2.36-13.74, Pâ <â .001) compared to the normal group. Similar results were observed across the various subgroups. As triglyceride levels increased, there was a corresponding increase in ICU admissions. Patients within the 1.7 to 5.65 mmol/L andâ >â 11.3 mmol/L triglyceride groups exhibited higher rates of ICU admissions. Moreover, we observed a higher risk of ICU hospitalization even with mild TG elevation.
Asunto(s)
Hospitalización , Hipertrigliceridemia , Unidades de Cuidados Intensivos , Pancreatitis , Triglicéridos , Humanos , Estudios Retrospectivos , Pancreatitis/sangre , Pancreatitis/epidemiología , Masculino , Femenino , Triglicéridos/sangre , Persona de Mediana Edad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Hipertrigliceridemia/sangre , Hipertrigliceridemia/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Anciano , Modelos Logísticos , Enfermedad AgudaRESUMEN
Acute necrotizing pancreatitis (ANP) is often associated with acute necrotic collection (ANC) or walled-off necrosis (WON). Due to the close anatomical connection between the pancreas, the spleen, and the transverse colon, necrotizing pancreatitis is often combined with spleen or colon involvement. Gastrointestinal dysfunction usually caused by pancreatitis leads to paralytic intestinal obstruction. However, pancreatitis combined with mechanical colonic obstruction is extremely rare. It can easily be misdiagnosed as malignant intestinal obstruction, and diagnosing the cause of intestinal obstruction becomes more critical when accompanied by Sinistral portal hypertension (SPH). Surgical resection is the primary method for the previous occurrence of colonic complications. In this case report, upon admission, a 37-year-old patient was diagnosed with acute necrotizing pancreatitis with sinistral portal hypertension. On the 6th day after admission, the patient developed a sudden colonic obstruction. After identifying the cause, the patient underwent a transanal decompression tube and minimally invasive necrosectomy, avoiding colon resection. In acute necrotizing pancreatitis combined with colonic mechanical obstruction, it is essential to clarify the etiology, and focus treatment on clearing the peripancreatic necrotic tissue, non-surgical treatment to deal with colonic obstruction is feasible, and the principle of individualized treatment should be used throughout the disease.
Asunto(s)
Pancreatitis Aguda Necrotizante , Hipertensión Portal Izquierda , Adulto , Humanos , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico , Diagnóstico Diferencial , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico , Hipertensión Portal Izquierda/complicaciones , Hipertensión Portal Izquierda/diagnóstico , Hipertensión Portal Izquierda/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: A series of randomized controlled trials have investigated the efficacy and safety of different timings of interventions and methods of intervention. However, the optimal treatment strategy is not yet clear. METHODS: We searched PubMed, EMBASE, ClinicalTrials.gov and the Cochrane Library until November 30, 2022. A systematic review and Bayesian network meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Trials comparing different treatment strategies for necrotizing pancreatitis were included. This study was registered in the Prospective Register of Systematic Reviews (CRD42022364409) to ensure transparency. RESULTS: We analyzed a total of 10 studies involving 570 patients and 8 treatment strategies. Although no statistically significant differences were identified comparing odds ratios, trends were confirmed by the surface under the cumulative ranking (SUCRA) scores. The interventions with a low rate of mortality were delayed surgery (DS), delayed surgical step-up approach (DSU) and delayed endoscopic step-up approach (DEU), while the interventions with a low rate of major complications were DSU, DEU and DS. According to the clustered ranking plot, DSU performed the best overall in reducing mortality and major complications, while DD performed the worst. Analysis of the secondary endpoints confirmed the superiority of DEU and DSU in terms of individual components of major complications (organ failure, pancreatic fistula, bleeding, and visceral organ or enterocutaneous fistula), exocrine insufficiency, endocrine insufficiency and length of stay. Overall, DSU was superior to other interventions. CONCLUSION: DSU was the optimal treatment strategy for necrotizing pancreatitis. Drainage alone should be avoided in clinical practice. Any interventions should be postponed for at least 4 weeks if possible. The step-up approach was preferred.