Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.3087
Peer-review started: January 2, 2020
First decision: February 19, 2020
Revised: February 23, 2020
Accepted: May 13, 2020
Article in press: May 13, 2020
Published online: June 14, 2020
In recent decades, an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis (IPN) because of the benefits in reducing postoperative multiple organ failure and mortality. However, there are limited published data regarding infection recurrence after treatment of this patient population.
To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.
Medical records for 193 IPN patients, who underwent minimally invasive treatment between February 2014 and October 2018, were retrospectively reviewed. Patients, who survived after the treatment, were divided into two groups: one group with infection after drainage catheter removal and another group without infection. The morphological and clinical data were compared between the two groups. Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence. Sensitivity and specificity for diagnostic performance were determined.
Of the 193 IPN patients, 178 were recruited into the study. Of them, 9 (5.06%) patients died and 169 patients survived but infection recurred in 13 of 178 patients (7.30%) at 7 (4-10) d after drainage catheters were removed. White blood cell (WBC) count, serum C-reactive protein (CRP), interleukin-6, and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without (all P < 0.05). In addition, drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection (P = 0.025 and P < 0.0001, respectively). Although these parameters all correlated positively with the incidence of infection (all P < 0.05), only WBC, CRP, procalcitonin levels, and catheter length were identified as independent predictors for infection recurrence. The sensitivity and specificity for infection prediction were high in WBC count (≥ 9.95 × 109/L) and serum procalcitonin level (≥ 0.05 ng/mL) but moderate in serum CRP level (cut-off point ≥ 7.37 mg/L). The catheter length (cut-off value ≥ 8.05 cm) had a high sensitivity but low specificity to predict the infection recurrence.
WBC count, serum procalcitonin, and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients. These biomarkers should be considered before removing the drainage catheters.
Core tip: This retrospective study investigated infection recurrence following successful minimally invasive treatment in infected pancreatic necrosis (IPN) patients. Our data demonstrated that infection recurred in 7.30% of IPN patients after drainage catheter removal. This can be predicted by white blood cell count, serum C-reactive protein, and procalcitonin levels measured at the time of catheter removal, and length of the catheter measured by computerized tomography scan. In particular, white blood cell count and serum procalcitonin level were highly sensitive and specific for predicting infection recurrence. These factors should be considered before removing the drainage catheters following minimally invasive treatment in IPN patients.