ABSTRACT
ObjectiveTo investigate the influence of portal vein thrombosis (PVT) on the short-term prognosis of patients with liver cirrhosis and the risk factors for the prognosis of patients with liver cirrhosis. MethodsA retrospective analysis was performed for the clinical data of the patients with liver cirrhosis who were hospitalized in our hospital from September 2018 to March 2020, among whom 58 patients with PVT were enrolled as PVT group and 116 patients without PVT were enrolled as non-PVT group, and 44 patients were selected from each group based on propensity score matching (PSM) at a ratio of 1∶1 to balance the covariates between groups. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method and the log-rank method were used to analyze survival status and bleeding before and after PSM, and the Cox risk model was used to analyze the risk factors for the prognosis of patients with liver cirrhosis. ResultsBefore PSM, the non-PVT group had a significantly higher overall survival rate than the PVT group (P=0.008), while after PSM, there was no significant difference in overall survival rate between the two groups (P=0.076). Before PSM, the non-PVT group had significantly lower incidence rates of upper gastrointestinal bleeding or rebleeding than the PVT group before and after PSM (P＜0.001), and the results after PSM were consistent with those before PSM (P=0.028). The multivariate analysis of the prognosis of the patients with liver cirrhosis before PSM showed that PVT (hazard ratio ［HR］=2.944, 95% confidence interval ［CI］: 1.364-6.441, P=0.007) and Model for End-Stage Liver Disease (MELD) score ≥15 (HR=3.531, 95% CI: 1.630-7.650, P=0.001) were risk factors for short-term death of the patients with liver cirrhosis, and the multivariate analysis after PSM showed that MELD score ≥15 (HR=3.312, 95% CI: 1.049-10457, P=0.041) was a risk factor for short-term death of the patients with liver cirrhosis. ConclusionLiver cirrhosis with PVT increases the risk of upper gastrointestinal bleeding or rebleeding, but it is not an independent risk factor for short-term death in patients with liver cirrhosis. MELD score ≥15 is an independent risk factor for short-term death in patients with liver cirrhosis.
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ObjectiveTo investigate the risk factors for new-onset diabetes after incipient acute pancreatitis (AP). MethodsA retrospective analysis was performed for 95 patients with post-acute pancreatitis diabetes mellitus (PPDM-A) after incipient AP who were admitted to The Affiliated Hospital of Southwest Medical University from June 2013 to January 2020 (PPDM-A group), and 190 patients without diabetes after incipient AP during the same period of time were selected at a ratio of 2∶1 and were enrolled as non-PPDM-A group. Baseline data and clinical data were collected. The t-test or the U test was used for comparison of continuous data, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data; a logistic regression analysis was used for multivariate analysis. Results There were significant differences between the two groups in body mass index (BMI), body weight, and proportion of patients with a drinking history, hyperuricemia, or fatty liver disease (all P＜0.05), while there were no significant differences between the two groups in age, male sex, and proportion of patients with a smoking history, a family history of diabetes, or hypertension (all P＞0.05). There were also significant differences in etiologies (biliary, hyperlipidemic, and alcoholic AP) between the two groups (P＜0.05). Compared with the non-PPDM-A group, the PPDM-A group had significantly higher triglyceride, blood glucose, white blood cell count (WBC), C-reactive protein, and proportion of patients with blood glucose ＞11.1 mmol/L on admission (all P＜0.05), while there were no significant differences in Ca2+, blood amylase, and blood lipase between the two groups (all P＞0.05). Compared with the non-PPDM-A group, the PPDM-A group had significantly higher incidence rates of acute peripancreatic necrotic collections and acute peripancreatic fluid collections, proportion of patients with multiple onset of AP, and proportion of patients with CTSI score ＞4 (all P＜0.05), while there were no significant differences in the proportion of patients with systemic inflammatory response syndrome and disease severity between the two groups (both P＞0.05). The multivariate analysis showed that the outcome of PPDM-A in alcoholic AP patients was 5.868 times that in biliary AP patients (95% confidence interval ［CI］: 1.607-21.418, P=0.007), and the outcome of PPDM-A in hyperlipidemic AP patients was 3.312 time that in biliary AP patients (95%CI: 1.593-6.887, P=0.001). The outcome of PPDM-A in overweight patients was 3.694 times that in patients with normal BMI (95%CI: 1.575-8.667, P=0.003), and the outcome of PPDM-A in obese patients was 5.964 times that in patients with normal BMI (95%CI: 2.516-14.139, P＜0.001). Multiple onset of AP (OR=4.522,95%CI: 2.298-8.900, P＜0.001), blood glucose on admission ＞11.1 mmol/L (OR=6.749,95% CI: 3.381-13.469, P＜0.001), CTSI score ＞4 (OR=1.176,95%CI: 1008-1.371, P=0.039), and WBC (OR=1.082,95%CI: 1.009-1.160, P=0.026) were independent risk factors for PPDM-A. ConclusionMultiple onset of AP, alcoholic AP, hyperlipidemic AP, blood glucose on admission ＞11.1 mmol/L, overweight or obesity, CTSI score ＞4, and WBC are independent risk factors for PPDM-A, which can provide a reference for formulating strategies to prevent or reduce the onset of PPDM-A.
ABSTRACT
ObjectiveTo investigate the features of patients with recurrence of hypertriglyceridemic acute pancreatitis (HTG-AP) and the influence of metabolic syndrome (MetS) on recurrence through a retrospective analysis. MethodsA retrospective analysis was performed for 132 patients with recurrent HTG-AP who were admitted to The Affiliated Hospital of Southwest Medical University from June 2013 to December(recurrence group), and 132 patients with non-recurrent HTG-AP who were treated during the same period of time were enrolled as control group. Related data were collected, including basic information (age, sex, diabetes, hypertension, and body mass index), clinical data (etiology, routine blood test results, and biochemical results), and complications ［systemic inflammatory response syndrome (SIRS), acute peripancreatic fluid collection (APFC), acute necrosis collection (ANC), acute respiratory distress syndrome (ARDS), acute renal failure (ARF), multiple organ dysfunction syndrome (MODS), and ICU admission rate］. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A logistic regression analysis was used for comparison of related variables, and the receiver operating characteristic (ROC) curve was used to validate the diagnostic value of variables. ResultsCompared with the control group, the recurrence group had a significantly higher proportion of patients with MetS, obesity, a high-density lipoprotein cholesterol (HDL-C) level of ＜1 mmol/L, or ANC and significantly higher levels of blood glucose and C-reactive protein (CRP) and white blood cell count (WBC) (χ2=9.138, χ2=6.823, χ2=13.251, χ2=9587, Z=-2.255, Z=-2.202, Z=-4.674, all P＜0.05). The 132 patients in the recurrence group were divided into MetS group with 92 patients and non-MetS group with 40 patients, and compared with the non-MetS group, the MetS group had significantly higher WBC and blood glucose and a significantly higher proportion of patients with SIRS, APFC, ANC, or progression to moderate-to-severe AP (MSAP) (t=2.434, t=4.881, χ2=4.513, χ2=7.936, χ2=7.031, χ2=7.150, all P＜0.05). MetS (odds ratio ［OR］=2.007, 95% confidence interval ［CI］: 1.152-3.497, P＜0.05), ANC (OR=2.270, 95%CI: 1.185-4.347, P＜0.05), and WBC (OR=1.135, 95%CI: 1.059-1.217, P＜0.05) were independent risk factors for recurrence in HTG-AP patients. The combination of MetS, ANC, and WBC had a relatively high value in predicting the recurrence of HTG-AP, with an area under the ROC curve of 0.692. In the recurrence group, the levels of triglyceride, blood glucose, and CRP and the proportion of patients with smoking, HDL-C ＜1 mmol/L, or obesity in 125 patients (7 patients were excluded due to incomplete case data) at the time of recurrence were significantly lower than those in 132 patients at initial admission (Z=-3.270,Z=-3.546,Z=-4.382,χ2=0547,χ2=8.259,χ2=5.143, all P＜0.05), with further reductions in the proportion of patients with MSAP, APFC, or ANC (χ2=4.086,χ2=11.930,χ2=4.967,all P＜005). ConclusionMetS aggravates disease severity in patients with recurrent HTG-AP and is an important factor for recurrence. Smoking cessation, weight loss, and oral lipid-lowering drugs can reduce disease severity at the time of readmission.