Lv C, Zhang ZX, Ke L. Early prediction and prevention of infected pancreatic necrosis. World J Gastroenterol 2024; 30(9): 1005-1010 [PMID: 38577189 DOI: 10.3748/wjg.v30.i9.1005]
Corresponding Author of This Article
Lu Ke, PhD, Associate Professor, Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan Road East, Nanjing 210000, Jiangsu Province, China. ctgkelu@nju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastroenterol. Mar 7, 2024; 30(9): 1005-1010 Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1005
Early prediction and prevention of infected pancreatic necrosis
Cheng Lv, Zi-Xiong Zhang, Lu Ke
Cheng Lv, Zi-Xiong Zhang, Lu Ke, Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, Jiangsu Province, China
Lu Ke, Research Institute of Critical Care Medicine and Emergency Rescue, Nanjing University, Nanjing 210000, Jiangsu Province, China
Author contributions: Lv C, Zhang ZX, and Ke L designed the research study; Lv C and Zhang ZX searched the literature and wrote the original manuscript; Ke L reviewed the manuscript and supervised the whole work; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lu Ke, PhD, Associate Professor, Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 305 Zhongshan Road East, Nanjing 210000, Jiangsu Province, China. ctgkelu@nju.edu.cn
Received: December 18, 2023 Peer-review started: December 18, 2023 First decision: December 28, 2023 Revised: January 2, 2024 Accepted: February 6, 2024 Article in press: February 6, 2024 Published online: March 7, 2024
Abstract
Approximately 20%-30% of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis (IPN), a highly morbid and potentially lethal complication. Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes. In the past two decades, several markers and predictive tools have been proposed and evaluated for this purpose. Conventional biomarkers like C-reactive protein, procalcitonin, lymphocyte count, interleukin-6, and interleukin-8, and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN. On the other hand, scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested, and the results showed that they may provide better accuracy. For early prevention of IPN, several new therapies were tested, including early enteral nutrition, antibiotics, probiotics, immune enhancement, etc., but the results varied. Taken together, several evidence-supported predictive markers and scoring systems are readily available for predicting IPN. However, effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition. In this editorial, we summarize evidence concerning early prediction and prevention of IPN, providing insights into future practice and study design. A more homogeneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN, thereby achieving individualized treatment.
Core Tip: Several evidence-supported predictive markers and scoring systems are readily available for predicting infected pancreatic necrosis (IPN). However, effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition. In future research and practice, a more homogeneous patient population should be targeted with reliable risk-stratification tools since such a strategy may help find the effective treatment to reduce the risk of IPN, thereby achieving individualized treatment.
