Risk factor analysis of pancreatic pseudocyst in patients with severe acute pancreatitis / 中华胰腺病杂志

ABSTRACT

Objective:To investigate the risk factors of pancreatic pseudocyst (PPC) in patients with severe acute pancreatitis (SAP).Methods:The clinical data of 142 SAP patients treated in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019 were collected and retrospectively analyzed. The patients were divided into two groups group with PPC ( n=48) and group without PPC ( n=94) according to whether they were complicated with PPC. The sex, age, body mass index, etiology, past history of diabetes or pancreatitis, modified CT severity index (MCTSI) score within 3 to 10 days of the onset, APACHEⅡ score within 48 hours of admission, fasting time, oxygenation index, hematocrit, white blood cell count, the percentage of neutrophil, serum procalcitonin (PCT), the levels of albumin, urea nitrogen(BUN), serum calcium, lactate dehydrogenase and creatinine, whether complicated with ascites and whether hemofiltration treatment was performed within 24 hours after admission were recorded. Univariate analysis and multivariate logistic stepwise regression were used to analyze the independent risk factors of PPC formation after SAP. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to evaluate the efficacy of each index in predicting the formation of PPC in patients with SAP. Results:Univariate analysis showed that PPC formation significantly correlated with MCTSI score, APACHEⅡ score, fasting time, PCT, serum albumin, BUN, lactate dehydrogenase, creatinine, serum calcium level and ascites ( P<0.05). Multivariate regression analysis showed that MCTSI score ( OR=1.81, 95% CI 1.273-2.571, P=0.001) and fasting time ( OR=1.083, 95% CI 1.002-1.171, P=0.044) were the risk factors for PPC formation in SAP patients. Serum albumin ( OR=0.875, 95% CI 0.781-0.979, P=0.02) and serum calcium ( OR=0.02, 95% CI 0.002-0.178, P<0.001) were the protective factors for PPC formations. AUC predicted by MCTSI score, fasting time, serum albumin and serum calcium levels for PPC formations in patients with SAP were 0.783 (95% CI 0.706-0.860), 0.650 (95% CI 0.553-0.746), 0.809(95% CI 0.738-0.881) and 0.855(95% CI 0.795-0.915) respectively, and the best cut-off values predicted were 7 points, 17.5 days, 33.5 g/L and 1.79 mmol/L. Conclusions:MCTSI score >7, fasting time >17.5 days, hypocalcemia and low albumin level were the independent risk factors for SAP complicated with PPC, which need close follow-up and timely intervention.