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