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 journalArticlepeer-review

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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 languageEnglish (US)
Pages (from-to)493-522
Number of pages30
JournalUpdates in Surgery
Issue number3
StatePublished - Apr 1 2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery


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