Analysis of factors influencing the complications of severe acute pancreatitis combined with hemorrhage

Abstract

Background The complication of hemorrhage in patients with severe acute pancreatitis (SAP) is an important influencing factor for poor prognosis, and the existing research is still insufficient. Therefore, this study aimed to analyze the influencing factors of hemorrhage in SAP patients. Methods Reviewing the clinical data of SAP patients admitted to our hospital from January 2019 to December 2022, this study evaluated the independent influencing factors of bleeding based on the propensity score matching method and multivariate logistic regression analysis, established a Nomogram prediction model for predicting SAP patients with concurrent bleeding, and drew the ROC curve while observing prognosis. Results A total of 804 patients were finally included according to the nadir criteria, and 97 (12.1%) were found to have hemorrhage complications. After screening by propensity score matching method, 440 patients were identified including 88 patients with bleeding. In univariate and multivariate logistic regression analysis, computed tomography severity index score (CTSI) score (OR: 1.771, 95% CI: 1.434–2.187, P < 0.001), Infected Pancreatic Necrosis (IPN) (OR: 4.407, 95% CI: 1.854–10.476, P < 0.001), Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 15 (OR: 12.323, 95% CI: 5.015–30.282, P < 0.001), Abdominal Compartment Syndrome (ACS) (OR: 3.685, 95% CI: 1.462–9.287, P = 0.006), and Continuous Renal Replacement Therapy (CRRT) (OR: 0.251, 95% CI: 0.094–0.670, P = 0.006) were identified as independent influencing factors for SAP with concurrent bleeding. Accordingly, we constructed a Nomogram prediction model with an area under the curve of the ROC curve of AUC of 0.924. The median time of hospital stay in ICU and total hospital stay was significantly higher in the bleeding group than in the non-bleeding group (30VS7, 48VS18, P < 0.001), and the number of deaths in the bleeding group was significantly higher than that in the non-bleeding group (46.6%VS6.5%, P < 0.001). Conclusion Complications of SAP hemorrhage suggest poor prognosis; therefore, for patients with elevated CTSI score and APACHE II score, combined IPN and ACS, the focus should be on strengthening hemorrhage surveillance, CRRT may be performed if necessary to improve the condition and reduce the risk of bleeding.