Management of infected acute necrotizing pancreatitis

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Background: In acute pancreatitis, secondary infection of pancreatic necrosis is a complication that mostly necessitates interventional therapy.A reliable prediction of infected necrotizing pancreatitis would enable an early identification of patients at risk, which however, is not possible yet.Methods: This study aims to identify parameters that are useful for the prediction of infected necrosis and to develop a prediction model for early detection.We conducted a retrospective analysis from the hospital information and reimbursement data system and screened 705 patients hospitalized with diagnosis of acute pancreatitis who underwent contrast-enhanced computed tomography and additional diagnostic puncture or drainage of necrotic collections.Both clinical and laboratory parameters were analyzed for an association with a microbiologically confirmed infected pancreatic necrosis.A prediction model was developed using a logistic regression analysis with stepwise inclusion of significant variables.The model quality was tested by receiver operating characteristics analysis and compared to single parameters and APACHE II score.Results: We identified a total of 89 patients with necrotizing pancreatitis, diagnosed by computed tomography, who additionally received biopsy or drainage.Out of these, 59 individuals had an infected necrosis.Eleven parameters showed a significant association with an infection including C-reactive protein, albumin, creatinine, and alcoholic etiology, which were independent variables in a predictive model.This model showed an area under the curve of 0.819, a sensitivity of 0.692 (95%-CI [0.547-0.809]),and a specificity of 0.840 (95%-CI [0.631-0.947]),outperforming single laboratory markers and APACHE II score.Even in cases of missing values predictability was reliable.Conclusion: A model consisting of a few single blood parameters and etiology of pancreatitis might help for differentiation between infected and non-infected pancreatic necrosis and assist medical therapy in acute necrotizing pancreatitis.

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