Characteristics and Incidence of Colon Complication in Necrotizing pancreatitis: A Propensity Score-Matched Study

Abstract

Objective

To clarify the incidence of colonic complications in patients with NP and their impact on prognosis.

Methods

The clinical data of NP patients admitted to the Department of General Surgery of Xuanwu Hospital, Capital Medical University from January 2014 to December 2020 were retrospectively analyzed. Patients were grouped according to the presence or absence of colonic complications, and the clinical prognosis of the two groups was analyzed after matching using a 1:1 propensity score, The primary study endpoint was patient mortality during hospitalization. Data are reported as median (range) or percentage of patients (%).

Results

A total of 306 patients with NP were included in this study, and the incidence of colonic complications was 12.4%, including 15 cases of colonic obstruction, 17 cases of colonic fistula, and 9 cases of colonic hemorrhage. Before matching, patients in the colonic group had severe admissions and poor clinical outcomes (P<0.05). After matching, the baseline data and clinical characteristics at admission were comparable between the two groups of patients. In terms of clinical outcomes, although the mortality was similar in the two groups (P>0.05), but patients in the colonic group were more likely to have multiorgan failure, length of nutrition support, number of minimally invasive interventions, number of extra-pancreatic infections, length of ICU stay and total length of stay were significantly higher than those of patients in the group without colonic complications (P<0.05). During long-term follow-up, patients in the colonic group were more likely to develop recurrent pancreatitis.

Conclusion

About 12.4% of NP patients developed colonic complications, and after PSM it was found that colonic complications only led to a longer hospital stay and an increased number of clinical interventions in NP patients and did not increase the mortality.

Keywords:

• necrotizing pancreatitis
• colon involvement
• propensity score match

Abbreviations

AP, Acute pancreatitis; NP, Necrotizing pancreatitis; CT, Computed tomography; MRI, Magnetic Resonance Image; MAP, Mild acute pancreatitis; RAP, Recurrent Acute pancreatitis; CP, Chronic pancreatitis; DSA, Digital subtraction angiography; POF, Persistent organ failure; NOF, New-onset organ failure; IPN, Infected pancreatic necrosis; EPI, Extra-pancreatic infection; ICU, Intensive care unit; PEI, Pancreatic exocrine dysfunction; MDT, Multidisciplinary team; MVT, Mechanical ventilation therapy; CRRT, Continuous renal replacement therapy; PSM, Propensity score matching; BMI, Body mass index; ERCP, Endoscopic retrograde cholangiography; CTSI, Computed tomography severity index; PCT, Procalcitonin; MOF, Multiple organ failure; SIRS, Systemic inflammatory response syndrome; EN, Enteral nutrition; PN, Parenteral nutrition.

Ethics Approval and Consent to Participate

The clinical data of patients in this study were collected from the database of Xuanwu Hospital, Capital Medical University, and have been reviewed and approved by the Review Committee of Xuanwu Hospital, Capital Medical University (No. 2020-158). Because this was a retrospective study that only analyzed existing clinical and follow-up data, the need to obtain informed patient consent was waived.

Acknowledgments

We would like to thank Professor Chun-jing Bian and Professor Ang Li for their guidance in this manuscript.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The research was supported by: 1. Beijing Municipal Science & Technology Commission (grant number: Z171100001017077); 2. Beijing Municipal Science and Technology Commission Clinical Diagnosis and Treatment Technology Research and Demonstration Application Project (grant number: Z191100006619038); 3. Capital Medical Development and Research Special Project (grant number: 2020-1-2012); 4. Construction Project of Clinical Advanced subjects of Capital Medical University (grant number: 1192070312); 5. Capital Medical Development and Research Special Project (grant number: Z201100005520090); 6. Beijing Medical Authority Cultivation Program (grant number: PX2022035).