Prognostic factors associated with development of infected necrosis in patients with acute necrotizing or severe pancreatitis-A systematic review and meta-analysis

Alexandre Tran; Shannon M Fernando; Bram Rochwerg; Kenji Inaba; Kimberly A Bertens; Paul T Engels; Fady K Balaa; Dalibor Kubelik; Maher Matar; Tori I Lenet; Guillaume Martel

doi:10.1097/TA.0000000000003502

Prognostic factors associated with development of infected necrosis in patients with acute necrotizing or severe pancreatitis-A systematic review and meta-analysis

J Trauma Acute Care Surg. 2022 May 1;92(5):940-948. doi: 10.1097/TA.0000000000003502. Epub 2021 Dec 20.

Authors

Alexandre Tran¹, Shannon M Fernando, Bram Rochwerg, Kenji Inaba, Kimberly A Bertens, Paul T Engels, Fady K Balaa, Dalibor Kubelik, Maher Matar, Tori I Lenet, Guillaume Martel

Affiliation

¹ From the Department of Surgery (A.T., K.A.B., F.K.B., D.K., M.M., T.I.L., G.M.), School of Epidemiology and Public Health (A.T., T.I.L., G.M.), Division of Critical Care, Department of Medicine (A.T., S.M.F., D.K.), Department of Emergency Medicine (S.M.F.), University of Ottawa, Ottawa; Department of Medicine (B.R.), Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton, ON, Canada; Division of Acute Care Surgery, Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Division of General Surgery, Department of Surgery (P.T.E.), and Division of Critical Care, Department of Medicine (P.T.E.), McMaster University, Hamilton, Canada.

PMID: 34936587
DOI: 10.1097/TA.0000000000003502

Abstract

Purpose: Acute pancreatitis is a potentially life-threatening condition with a wide spectrum of clinical presentation and illness severity. An infection of pancreatic necrosis (IPN) results in a more than twofold increase in mortality risk as compared with patients with sterile necrosis. We sought to identify prognostic factors for the development of IPN among adult patients with severe or necrotizing pancreatitis.

Methods: We conducted this prognostic review in accordance with systematic review methodology guidelines. We searched six databases from inception through March 21, 2021. We included English language studies describing prognostic factors associated with the development of IPN. We pooled unadjusted odds ratio (uOR) and adjusted odds ratios (aOR) for prognostic factors using a random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the GRADE approach.

Results: We included 31 observational studies involving 5,210 patients. Factors with moderate or higher certainty of association with increased IPN risk include older age (uOR, 2.19; 95% confidence interval [CI], 1.39-3.45, moderate certainty), gallstone etiology (aOR, 2.35; 95% CI, 1.36-4.04, high certainty), greater than 50% necrosis of the pancreas (aOR, 3.61; 95% CI, 2.15-6.04, high certainty), delayed enteral nutrition (aOR, 2.09; 95% CI, 1.26-3.47, moderate certainty), multiple or persistent organ failure (aOR, 11.71; 95% CI, 4.97-27.56, high certainty), and invasive mechanical ventilation (uOR, 12.24; 95% CI, 2.28-65.67, high certainty).

Conclusion: This meta-analysis confirms the association between several clinical early prognostic factors and the risk of IPN development among patients with severe or necrotizing pancreatitis. These findings provide the foundation for the development of an IPN risk stratification tool to guide more targeted clinical trials for prevention or early intervention strategies.

Level of evidence: Systematic review and meta-analysis, Level IV.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Acute Disease
Adult
Humans
Intraabdominal Infections*
Necrosis
Pancreatitis, Acute Necrotizing* / complications
Pancreatitis, Acute Necrotizing* / diagnosis
Pancreatitis, Acute Necrotizing* / therapy
Prognosis