Annals of surgery · 2025
Predictors for Successful Treatment of Infected Necrotizing Pancreatitis With Antibiotics Alone: A Nationwide Prospective Cohort.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Pauw Hannah S, Timmerhuis Hester C, Boxhoorn Lotte, Sissingh Noor J, Voermans Rogier P, Besselink Marc G, Sieswerda Elske, Daamen Lois A, Bouwense Stefan A W, Bollen Thomas L, van Hooft Jeanin E, van den Berg Fons F, Verdonk Robert, van Santvoort Hjalmar C, Dutch Pancreatitis Study Group
Аннотация
OBJECTIVE: To identify predictors for successful treatment of patients with infected necrotizing pancreatitis with antibiotics alone.
BACKGROUND: Infected necrotizing pancreatitis is associated with mortality ranging from 15% to 35%. Recent studies have shown that in some patients, treatment with antibiotics alone is successful, thus avoiding invasive procedures.
METHODS: We performed a post hoc analysis of a prospective cohort of 305 patients with suspected or proven infected necrotizing pancreatitis from 22 Dutch hospitals. The primary outcome was successful treatment with antibiotics alone (ie, survival without radiologic, endoscopic, or surgical intervention). All computed tomography images were reviewed to classify the pattern of pancreatic necrosis. A prediction model using clinical and radiologic predictors was created using multivariable logistic regression. A prognostic nomogram was developed based on the final predictors.
RESULTS: Overall, 86 out of 305 patients (28%) with infected necrotizing pancreatitis were successfully treated with antibiotics alone. Our final prediction model included presence of organ failure at the start of antibiotics [odds ratio (OR): 0.46, 95% CI: 0.22-0.99, P =0.046], presence of central necrosis (OR: 0.11, 95% CI: 0.05-0.23, P <0.001) and presence of subtotal necrosis (OR: 0.12, 95% CI: 0.03-0.36, P <0.001). The area under the curve was 0.74 (95% CI: 0.70-0.75). The prognostic nomogram yielded a probability of successful antibiotic treatment of 5% when organ failure and central necrosis were present and 47% when all predictors were absent.
CONCLUSIONS: In patients with infected necrotizing pancreatitis, predictors negatively impacting successful treatment with antibiotics are organ failure at the start of antibiotics, and the presence of central or subtotal necrosis on imaging.
BACKGROUND: Infected necrotizing pancreatitis is associated with mortality ranging from 15% to 35%. Recent studies have shown that in some patients, treatment with antibiotics alone is successful, thus avoiding invasive procedures.
METHODS: We performed a post hoc analysis of a prospective cohort of 305 patients with suspected or proven infected necrotizing pancreatitis from 22 Dutch hospitals. The primary outcome was successful treatment with antibiotics alone (ie, survival without radiologic, endoscopic, or surgical intervention). All computed tomography images were reviewed to classify the pattern of pancreatic necrosis. A prediction model using clinical and radiologic predictors was created using multivariable logistic regression. A prognostic nomogram was developed based on the final predictors.
RESULTS: Overall, 86 out of 305 patients (28%) with infected necrotizing pancreatitis were successfully treated with antibiotics alone. Our final prediction model included presence of organ failure at the start of antibiotics [odds ratio (OR): 0.46, 95% CI: 0.22-0.99, P =0.046], presence of central necrosis (OR: 0.11, 95% CI: 0.05-0.23, P <0.001) and presence of subtotal necrosis (OR: 0.12, 95% CI: 0.03-0.36, P <0.001). The area under the curve was 0.74 (95% CI: 0.70-0.75). The prognostic nomogram yielded a probability of successful antibiotic treatment of 5% when organ failure and central necrosis were present and 47% when all predictors were absent.
CONCLUSIONS: In patients with infected necrotizing pancreatitis, predictors negatively impacting successful treatment with antibiotics are organ failure at the start of antibiotics, and the presence of central or subtotal necrosis on imaging.