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
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:
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.
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
Research background

Infected pancreatic necrosis (IPN) is a vital condition. Without interventional treatment, its mortality rate is high. In recent decades, the development of minimally invasive interventional therapies provides benefits in reducing postoperative multiple organ failure and mortality. Therefore, they have been applied to an increasing number of IPN patients. There are limited data in clinical guidelines regarding infection recurrence.

Research motivation

To date, the most commonly reported complications of minimally invasive treatment in IPN patients include fistula, perforation, colonic injury, and pericatheter leaking. However, the infection recurrence after treatment in this patient population is not clear. The study in this aspect will certainly provide evidence for its clinical management and prevention.

Research objectives

This study investigated the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.

Research methods

Medical records for IPN patients who underwent minimally invasive treatment 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.

Research 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. WBC count, serum CRP, IL-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 white blood cell (WBC), C-reactive protein (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 length of catheter (cut-off value ≥ 8.05 cm) had a high sensitivity but low specificity to predict the infection recurrence.

Research conclusion

This study confirmed that 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.

Research perspective

This is the first study to unveil the high sensitivity and specificity of WBC count and serum procalcitonin level for predicting infection recurrence following minimally invasive treatment in IPN patients. Our findings suggest that these factors should be considered before removing the drainage catheters in clinical practice. Further study in a big patient population is required.