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Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Predictors for Successful Treatment of Infected Necrotizing Pancreatitis With Antibiotics Alone: A Nationwide
Hannah S Pauw1,2, Hester C Timmerhuis1,2, Lotte Boxhoorn3,4
1Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Objective:
To identify predictors for successful treatment of patients with infected necrotizing pancreatitis with antibiotics alone.
Background:
Infected necrotizing pancreatitis is associated with mortality ranging from 15% to 35%. Recent studies have shown that in some patients, treatment with antibiotics alone is successful, thus avoiding invasive procedures.
Methods:
We performed a post hoc analysis of a prospective cohort of 305 patients with suspected or proven infected necrotizing pancreatitis from 22 Dutch hospitals. The primary outcome was successful treatment with antibiotics alone (ie, survival without radiologic, endoscopic, or surgical intervention). All computed tomography images were reviewed to classify the pattern of pancreatic necrosis. A prediction model using clinical and radiologic predictors was created using multivariable logistic regression. A prognostic nomogram was developed based on the final predictors.
Results:
Overall, 86 out of 305 patients (28%) with infected necrotizing pancreatitis were successfully treated with antibiotics alone. Our final prediction model included presence of organ failure at the start of antibiotics [odds ratio (OR): 0.46, 95% CI: 0.22-0.99, P =0.046], presence of central necrosis (OR: 0.11, 95% CI: 0.05-0.23, P <0.001) and presence of subtotal necrosis (OR: 0.12, 95% CI: 0.03-0.36, P <0.001). The area under the curve was 0.74 (95% CI: 0.70-0.75). The prognostic nomogram yielded a probability of successful antibiotic treatment of 5% when organ failure and central necrosis were present and 47% when all predictors were absent.
Conclusions:
In patients with infected necrotizing pancreatitis, predictors negatively impacting successful treatment with antibiotics are organ failure at the start of antibiotics, and the presence of central or subtotal necrosis on imaging.
Insights
Successful antibiotic treatment for infected necrotizing pancreatitis is predicted by the absence of organ failure and limited necrosis. These findings help identify patients who may avoid invasive procedures.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Surgical Critical Care
Background:
- Infected necrotizing pancreatitis carries a significant mortality risk (15-35%).
- Antibiotic therapy alone can successfully treat some patients, avoiding invasive interventions.
Purpose of the Study:
- To identify predictors of successful non-invasive treatment for infected necrotizing pancreatitis using antibiotics alone.
- To develop a predictive model for antibiotic treatment success in this patient population.
Main Methods:
- A post-hoc analysis of a prospective cohort of 305 patients with infected necrotizing pancreatitis was conducted.
- Computed tomography (CT) imaging was used to classify necrosis patterns.
- Multivariable logistic regression was employed to create a prediction model and prognostic nomogram.
Main Results:
- 28% (86/305) of patients achieved successful treatment with antibiotics alone.
- Key negative predictors for successful antibiotic treatment included organ failure at baseline, central necrosis, and subtotal necrosis.
- The prediction model demonstrated an area under the curve of 0.74.
Conclusions:
- Organ failure at the onset of antibiotic therapy and extensive necrosis (central or subtotal) are significant predictors against successful treatment.
- A prognostic nomogram can estimate the probability of successful antibiotic treatment based on identified clinical and radiological factors.
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