Clinical features and prediction of 152 patients of acute pancreatitis complicated with portal vein system thrombosis / 中华消化杂志

ABSTRACT

Objective:To explore the clinical features of acute pancreatitis (AP) complicated with portal vein system thrombosis (PVST) and the clinical prediction of symptomatic PVST.Methods:From January 2014 to December 2019, at First Affiliated Hospital and Second Affiliated Hospital of Kunming Medical University, 152 hospitalized patients who met the diagnostic criteria of AP complicated with PVST and had complete clinical data were retrospectively analyzed, and the clinical characteristics of them were analyzed. According to whether there were clinical manifestations caused by PVST (esophago-gastric variceal bleeding, persistent ascites, intestinal ischemia), AP patients complicated with PVST were divided into symptomatic group ( n=48) and asymptomatic group ( n=104). The differences in general information, laboratory test indicators, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Balthazar computed tomography (CT) score, local and systemic complications were compared between symptomatic group and asymptomatic group. Two independent sample t test, two sample rank sum test, and chi-square test were used for statistical analysis. The binary logistic regression was used for multivariate analysis. Results:The severe acute pancreatitis (SAP) complicated with PVST was common, accounted for 73.0% (111/152), and the hospital mortality rate was 14.5% (22/152). The splenic vein (46.1%, 70/152) was the most common single vessel involved. The hospital stay of the symptomatic group was longer than that of the asymptomatic group, the hospitalization costs and hospital mortality of the symptomatic group were both higher than those of the asymptomatic group ((26.31±19.38) d vs. (15.11±9.31) d, (103 463.68±15 312.74) yuan vs. (37 199.38±4 647.17) yuan, 25.0%, 12/48 vs. 9.6%, 10/104, respectively), and the differences were statistically significant ( t=-3.809 and -4.141, χ2=6.280; all P<0.05). The lactic acid dehydrogenase, C-reactive protein, and prothrombin time of the symptomatic group were all higher than those of the asymptomatic group (4.78 μmol·s -1·L -1, 2.96 μmol·s -1·L -1 to 7.82 μmol·s -1·L -1 vs. 4.42 μmol·s -1·L -1, 3.29 μmol·s -1·L -1 to 9.30 μmol·s -1·L -1; 69.53 mg/L, 29.49 mg/L to 147.14 mg/L vs. 40.90 mg/L, 8.88 mg/L to 104.89 mg/L; (16.88±8.23) s vs. (14.12±1.59) s), however the hematocrit and blood calcium in the symptomatic group were both lower than those of the asymptomatic group ((34.97±8.96)% vs. (39.18±7.17)%, (2.01±0.32) mmol/L vs. (2.17±0.19) mmol/L), and the differences were all statistically significant ( Z=-2.067 and -1.977, t=-2.281, 3.072 and 3.083; all P<0.05). The scores of APACHE Ⅱand Balthazar CT, the rate of local complications of pancreatic necrosis, and systemic complications including abdominal hemorrhage, septic shock, acute respiratory distress syndrome, lung infection and pleural effusion of the symptomatic group were higher than those of the asymptomatic group (7.21±3.84 vs. 5.27±2.31, 7.10±1.57 vs. 4.83±1.87, 87.5%, 42/48 vs. 28.8%, 30/104; 10.4%, 5/48 vs. 1.9%, 2/104; 18.8%, 9/48 vs. 1.9%, 2/104; 25.0%, 12/48 vs. 3.8%, 4/104; 91.7%, 44/48 vs. 60.6%, 63/104; 85.4%, 41/48 vs. 49.0%, 51/104; respectively), and the differences were statistically significant ( t=-3.241 and -7.331, χ2=45.320, 5.393, 13.852, 15.604, 15.323 and 18.191; all P<0.05). The results of binary logistic regression showed that Balthazar CT score was an independent risk factor for symptomatic PVST ( P<0.01), and odds ratio (95% confidence interval) was 1.79 (1.41 to 2.29). Conclusions:Balthazar CT score is an influencing factor of symptomatic PVST in AP patients, and patients with high scores should be treated early to improve the prognosis.