Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2020; 26(22): 3087-3097
Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.3087
Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis
Chong-Chong Gao, Jia Li, Feng Cao, Xiao-Hui Wang, Ang Li, Zhe Wang, Fei Li
Chong-Chong Gao, Jia Li, Feng Cao, Xiao-Hui Wang, Ang Li, Zhe Wang, Fei Li, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Gao CC designed and performed the research and wrote the paper; Li F designed the research and supervised the report; Cao F, Wang XH, and Li J designed the research and contributed to the analysis; Li A and Wang Z provided clinical advice.
Supported by Beijing Municipal Science and Technology Commission, No. Z171100001017077; Beijing Municipal Administration of Hospitals Clinical Medicine Development of special funding support, No. XMLX201404; and Construction Project of Advanced Clinical Medicine Discipline of Capital Medical University, No. 1192070312.
Institutional review board statement: The study was reviewed approved by the ethics committee of Xuanwu Hospital.
Informed consent statement: Due to the nature of retrospective study, written informed consents were waived.
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at feili36@ccmu.edu.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fei Li MD, PhD, Chief Doctor, Professor, Surgeon, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. feili36@ccmu.edu.cn
Received: January 2, 2020
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
Abstract
BACKGROUND

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.

AIM

To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Infectious pancreatic necrosis, Drainage, Minimally invasive intervention, Infection recurrence, C-reactive protein, Procalcitonin

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.