Early-onset emphysematous pancreatitis indicates poor outcomes in patients with infected pancreatic necrosis

Jiarong Li; Chiayen Lin; Caihong Ning; Qin Wei; Lu Chen; Shuai Zhu; Dingcheng Shen; Gengwen Huang

doi:10.1016/j.dld.2022.04.001

Early-onset emphysematous pancreatitis indicates poor outcomes in patients with infected pancreatic necrosis

Dig Liver Dis. 2022 Nov;54(11):1527-1532. doi: 10.1016/j.dld.2022.04.001. Epub 2022 Apr 18.

Authors

Jiarong Li¹, Chiayen Lin¹, Caihong Ning¹, Qin Wei¹, Lu Chen¹, Shuai Zhu¹, Dingcheng Shen², Gengwen Huang³

Affiliations

¹ Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
² Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China. Electronic address: shendch@mail2.sysu.edu.cn.
³ Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China. Electronic address: huanggengwen@csu.edu.cn.

PMID: 35450815
DOI: 10.1016/j.dld.2022.04.001

Abstract

Background: Emphysematous pancreatitis (EP) is a subtype of infected pancreatic necrosis (IPN) characterized by presence of gas in (peri)pancreatic necrosis. However, the impacts of EP on outcomes of IPN are still controversial.

Methods: A prospective database of consecutive patients with IPN in a tertiary hospital was post-hoc analyzed. Patients were assigned to EP and non-EP groups to perform a comprehensive comparison.

Results: A total of 178 patients with IPN were enrolled and the overall mortality was 30.9%. EP accounted for 20.8% (n = 37) of cases and was significantly associated with higher incidences of Escherichia coli (45.9 versus 18.4%, P = 0.001) and Klebsiella pneumoniae (56.8 versus 33.3%, P = 0.009) infection. There was scarcely any disparity in clinical characteristics and outcomes between IPN patients with and without EP. However, patients with early-onset EP defined as air bubble signs occurring within 2 weeks from disease onset were significantly older and have higher prevalence of history of diabetes, and they were also associated with significantly higher mortality (57.1 versus 8.7%, P = 0.015) compared with late-onset patients.

Conclusions: The clinical outcomes of EP might be like those of non-emphysematous infection. However, when EP occurs within 2 weeks from disease onset, it is highly lethal.

Keywords: Emphysematous pancreatitis; Infected pancreatic necrosis; Outcomes.

MeSH terms

Emphysema* / complications
Humans
Necrosis
Pancreatitis, Acute Necrotizing* / complications
Pancreatitis, Acute Necrotizing* / diagnostic imaging