Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Mauro Podda; Gianluca Pellino; Salomone Di Saverio; Federico Coccolini; Daniela Pacella; Stefano Piero Bernardo Cioffi; Francesco Virdis; Andrea Balla; Benedetto Ielpo; Francesco Pata; Gaetano Poillucci; Monica Ortenzi; Dimitrios Damaskos; Belinda De Simone; Massimo Sartelli; Ari Leppaniemi; Kumar Jayant; Fausto Catena; Antonio Giuliani; Marcello Di Martino; Adolfo Pisanu; Chiara Gerardi; Stavros Gourgiotis; Cristiana Riboni; Alessio Giordano; Luca Ferrario; Vanni Agnoletti; Yoram Kruger; Damian Mole; Ferdinando Agresta; Mikel Prieto Calvo; Michael Wilson; Fiammetta Soggiu; Alaa Hamdan; Carlos Augusto Gomes; Gustavo Fraga; Argyrios Ioannidis; Zaza Demetrashvili; Saaz Sahani; Lovenish Bains; Almu’atasim Khamees; Hazim Ababneh; Osama Aljaiuossi; Samuel Pimentel; Ikhwan Sani Mohamad; Ahmad Ramzi Yusoff; Narcis Octavian Zarnescu; Valentin Calu; Andrey Litvin; Diana Robayo

doi:10.1007/s13304-023-01488-6

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Mauro Podda, Gianluca Pellino, Salomone Di Saverio, Federico Coccolini, Daniela Pacella, Stefano Piero Bernardo Cioffi, Francesco Virdis, Andrea Balla, Benedetto Ielpo, Francesco Pata, Gaetano Poillucci, Monica Ortenzi, Dimitrios Damaskos, Belinda De Simone, Massimo Sartelli, Ari Leppaniemi, Kumar Jayant, Fausto Catena, Antonio Giuliani, Marcello Di MartinoAdolfo Pisanu, Chiara Gerardi, Stavros Gourgiotis, Cristiana Riboni, Alessio Giordano, Luca Ferrario, Vanni Agnoletti, Yoram Kruger, Damian Mole, Ferdinando Agresta, Mikel Prieto Calvo, Michael Wilson, Fiammetta Soggiu, Alaa Hamdan, Carlos Augusto Gomes, Gustavo Fraga, Argyrios Ioannidis, Zaza Demetrashvili, Saaz Sahani, Lovenish Bains, Almu’atasim Khamees, Hazim Ababneh, Osama Aljaiuossi, Samuel Pimentel, Ikhwan Sani Mohamad, Ahmad Ramzi Yusoff, Narcis Octavian Zarnescu, Valentin Calu, Andrey Litvin, Diana Robayo

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].

Original language	English (US)
Pages (from-to)	493-522
Number of pages	30
Journal	Updates in Surgery
Volume	75
Issue number	3
DOIs	https://doi.org/10.1007/s13304-023-01488-6
State	Published - Apr 1 2023
Externally published	Yes

All Science Journal Classification (ASJC) codes

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s13304-023-01488-6

Cite this

Podda, M., Pellino, G., Di Saverio, S., Coccolini, F., Pacella, D., Cioffi, S. P. B., Virdis, F., Balla, A., Ielpo, B., Pata, F., Poillucci, G., Ortenzi, M., Damaskos, D., De Simone, B., Sartelli, M., Leppaniemi, A., Jayant, K., Catena, F., Giuliani, A., ... Robayo, D. (2023). Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study. Updates in Surgery, 75(3), 493-522. https://doi.org/10.1007/s13304-023-01488-6

@article{5d27fd77b5b746e0899764cea9c5263b,

title = "Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study",

abstract = "The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].",

author = "Mauro Podda and Gianluca Pellino and {Di Saverio}, Salomone and Federico Coccolini and Daniela Pacella and Cioffi, {Stefano Piero Bernardo} and Francesco Virdis and Andrea Balla and Benedetto Ielpo and Francesco Pata and Gaetano Poillucci and Monica Ortenzi and Dimitrios Damaskos and {De Simone}, Belinda and Massimo Sartelli and Ari Leppaniemi and Kumar Jayant and Fausto Catena and Antonio Giuliani and {Di Martino}, Marcello and Adolfo Pisanu and Chiara Gerardi and Stavros Gourgiotis and Cristiana Riboni and Alessio Giordano and Luca Ferrario and Vanni Agnoletti and Yoram Kruger and Damian Mole and Ferdinando Agresta and {Prieto Calvo}, Mikel and Michael Wilson and Fiammetta Soggiu and Alaa Hamdan and Gomes, {Carlos Augusto} and Gustavo Fraga and Argyrios Ioannidis and Zaza Demetrashvili and Saaz Sahani and Lovenish Bains and Almu{\textquoteright}atasim Khamees and Hazim Ababneh and Osama Aljaiuossi and Samuel Pimentel and Mohamad, {Ikhwan Sani} and Yusoff, {Ahmad Ramzi} and Zarnescu, {Narcis Octavian} and Valentin Calu and Andrey Litvin and Diana Robayo",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = apr,

day = "1",

doi = "10.1007/s13304-023-01488-6",

language = "English (US)",

volume = "75",

pages = "493--522",

journal = "Updates in Surgery",

issn = "2038-131X",

publisher = "Springer-Verlag Italia",

number = "3",

}

Podda, M, Pellino, G, Di Saverio, S, Coccolini, F, Pacella, D, Cioffi, SPB, Virdis, F, Balla, A, Ielpo, B, Pata, F, Poillucci, G, Ortenzi, M, Damaskos, D, De Simone, B, Sartelli, M, Leppaniemi, A, Jayant, K, Catena, F, Giuliani, A, Di Martino, M, Pisanu, A, Gerardi, C, Gourgiotis, S, Riboni, C, Giordano, A, Ferrario, L, Agnoletti, V, Kruger, Y, Mole, D, Agresta, F, Prieto Calvo, M, Wilson, M, Soggiu, F, Hamdan, A, Gomes, CA, Fraga, G, Ioannidis, A, Demetrashvili, Z, Sahani, S, Bains, L, Khamees, A, Ababneh, H, Aljaiuossi, O, Pimentel, S, Mohamad, IS, Yusoff, AR, Zarnescu, NO, Calu, V, Litvin, A & Robayo, D 2023, 'Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study', Updates in Surgery, vol. 75, no. 3, pp. 493-522. https://doi.org/10.1007/s13304-023-01488-6

TY - JOUR

T1 - Infected pancreatic necrosis

T2 - outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

AU - Podda, Mauro

AU - Pellino, Gianluca

AU - Di Saverio, Salomone

AU - Coccolini, Federico

AU - Pacella, Daniela

AU - Cioffi, Stefano Piero Bernardo

AU - Virdis, Francesco

AU - Balla, Andrea

AU - Ielpo, Benedetto

AU - Pata, Francesco

AU - Poillucci, Gaetano

AU - Ortenzi, Monica

AU - Damaskos, Dimitrios

AU - De Simone, Belinda

AU - Sartelli, Massimo

AU - Leppaniemi, Ari

AU - Jayant, Kumar

AU - Catena, Fausto

AU - Giuliani, Antonio

AU - Di Martino, Marcello

AU - Pisanu, Adolfo

AU - Gerardi, Chiara

AU - Gourgiotis, Stavros

AU - Riboni, Cristiana

AU - Giordano, Alessio

AU - Ferrario, Luca

AU - Agnoletti, Vanni

AU - Kruger, Yoram

AU - Mole, Damian

AU - Agresta, Ferdinando

AU - Prieto Calvo, Mikel

AU - Wilson, Michael

AU - Soggiu, Fiammetta

AU - Hamdan, Alaa

AU - Gomes, Carlos Augusto

AU - Fraga, Gustavo

AU - Ioannidis, Argyrios

AU - Demetrashvili, Zaza

AU - Sahani, Saaz

AU - Bains, Lovenish

AU - Khamees, Almu’atasim

AU - Ababneh, Hazim

AU - Aljaiuossi, Osama

AU - Pimentel, Samuel

AU - Mohamad, Ikhwan Sani

AU - Yusoff, Ahmad Ramzi

AU - Zarnescu, Narcis Octavian

AU - Calu, Valentin

AU - Litvin, Andrey

AU - Robayo, Diana

PY - 2023/4/1

Y1 - 2023/4/1

N2 - The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].

AB - The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].

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UR - http://www.scopus.com/inward/citedby.url?scp=85149769690&partnerID=8YFLogxK

U2 - 10.1007/s13304-023-01488-6

DO - 10.1007/s13304-023-01488-6

M3 - Article

C2 - 36899292

AN - SCOPUS:85149769690

SN - 2038-131X

VL - 75

SP - 493

EP - 522

JO - Updates in Surgery

JF - Updates in Surgery

IS - 3

ER -

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

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