Predictors of outcome of percutaneous catheter drainage in patients with acute pancreatitis having acute fluid collection and development of a predictive model

Bellam, Balaji L; Samanta, Jayanta; Gupta, Pankaj; Kumar‐M, Praveen; Sharma, Vishal; Dhaka, Narendra; Sarma, Phulen; Muktesh, Gaurav; Gupta, Vikas; Sinha, Saroj Kant; Kochhar, Rakesh

doi:10.1016/j.pan.2019.05.467

Cited by 19 publications

(16 citation statements)

References 28 publications

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“…Therefore, there was no need to wait for the formation and enlargement of the sinus tract, resulting in a shorter time required for expanding the sinus tract and duration of catheter placement. The drainage time used in this study was much less than that (28 days; 46 days) reported in previous studies [12,23]. No extra infection-related complications occurred in this study.…”

Section: Discussionmentioning

confidence: 47%

Triple guidance of choledochoscopy, ultrasonography, and computed tomography facilitates percutaneous catheter drainage of infected walled-off necrosis

Hui

Wen²,

et al. 2021

Insights Imaging

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Objectives Percutaneous catheter drainage (PCD) is usually performed to treat acute pancreatitis complicated by infected walled-off necrosis (WON). Insufficient drainage of infected WON may lead to a prolonged recovery process. Here, we introduce a modified PCD strategy that uses the triple guidance of choledochoscopy, ultrasonography, and computed tomography (CUC-PCD) to improve the therapeutic efficiency. Methods This study retrospectively analysed 73 patients with acute pancreatitis-related WON from January 2015 to January 2021. The first 38 patients were treated by ultrasonography/computed tomography-guided PCD (UC-PCD), and the next consecutive 35 patients by CUC-PCD. Perioperative data, procedural technical information, treatment outcomes, and follow-up data were collected. Results Demographic characteristics were statistically comparable between the two treatment groups (p > 0.05). After 48 h of PCD treatment, the CUC-PCD group achieved a significantly smaller size of the infected WON (p = 0.023), lower inflammatory response indexes (p = 0.020 for white blood cells, and p = 0.031 for C-reactive protein), and severity scores than the UC-PCD group (p < 0.05). Less catheter duration (p = 0.001), hospitalisation duration (p = 0.000), and global costs (p = 0.000) were observed in the CUC-PCD group compared to the UC-PCD group. There were no differences between the two groups regarding the rate of complications. Conclusions CUC-PCD is a safe and efficient approach with potential clinical applicability for treating infected WON owing to its feasibility in placing the drainage catheter at the optimal location in real time and performing primary necrosectomy without sinus tract formation and enlargement.

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Section: Discussionmentioning

confidence: 47%

Triple guidance of choledochoscopy, ultrasonography, and computed tomography facilitates percutaneous catheter drainage of infected walled-off necrosis

Hui

Wen²,

et al. 2021

Insights Imaging

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“…Fall in IL-6 and CRP correlated with the outcomes of patients managed with PCD. Other investigators have explored the role of CT density of the collection, serial volume measurement of the collection, and resolution of OF to predict response to PCD[ 13 , 14 ]. WBC is a simple and inexpensive test routinely performed during the initial evaluation and follow-up of hospitalized patients with AP[ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…PCD is sufficient to manage collections in AP in almost 50% of cases[ 8 , 12 ]. Predicting response to PCD is critical to decide additional interventions[ 13 ]. Previous studies have identified computed tomography (CT) density of the collection, OF resolution, and volume reduction of the fluid collection after one week of PCD as significant predictors of successful PCD outcomes[ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Predicting response to PCD is critical to decide additional interventions[ 13 ]. Previous studies have identified computed tomography (CT) density of the collection, OF resolution, and volume reduction of the fluid collection after one week of PCD as significant predictors of successful PCD outcomes[ 13 , 14 ]. A few studies have reported the utility of inflammatory markers in predicting the response to PCD[ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis

Gupta¹,

Das²,

Bansal³

et al. 2022

WJCC

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BACKGROUND Early prediction of response to percutaneous catheter drainage (PCD) of necrotic collections in acute pancreatitis (AP) using simple and objective tests is critical as it may determine patient prognosis. The role of white blood cell (WBC) count and neutrophil-lymphocyte ratio (NLR) has not been assessed as a tool of early prediction of PCD success and is the focus of this study. AIM To assess the value of WBC and NLR in predicting response to PCD in AP. METHODS This retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019. Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score. WBC and NLR were monitored 24 h prior PCD (WBC-0/NLR-0) and 24 h (WBC-1/NLR-1), 48 h (WBC-2/NLR-2) and 72 h (WBC-3/NLR-3) after PCD. NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. The association of success of PCD (defined as survival without the need for surgery) with WBC and NLR was assessed. The trend of WBC and NLR was also assessed post PCD. RESULTS One hundred fifty-five patients [median age 40 ± 13.6 (SD), 64.5% males, 53.5% severe AP] were included in the final analysis. PCD was done for acute necrotic collection in 99 (63.8%) patients and walled-off necrosis in 56 (36.1%) patients. Median pain to PCD interval was 24 ± 69.89 d. PCD was successful in 109 patients (group 1) and 46 patients (group 2) who failed to respond. There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure. Both WBC and NLR showed an overall decreasing trend. There was a significant difference between WBC-0 and WBC-1 ( P = 0.0001). WBC-1 and NLR-1 were significantly different between the two groups ( P = 0.048 and 0.003, respectively). The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682, respectively. At a cut-off value of 9.87 for NLR-1, the sensitivity and specificity for predicting the success of PCD were calculated to be 75% and 65.4% respectively. CONCLUSION WBC and NLR can be used as simple tests for predicting response to PCD in patients with acute necrotizing pancreatitis.

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“…However, due to their rapid time-course changes in serum concentration, nonspeci city, cost, complexity, and suboptimal accuracy, none of the biochemical biomarkers have been adopted into routine clinical practice. In recent years, different nomograms have been applied for predicting severity (mortality) [16][17][18][19], splanchnic vein thrombosis [20], abdominal infection [21], computed tomography index for assessing AP outcomes [22] and catheter drainage in necrotizing AP [23,24] as well as for oral refeeding intolerance during hospital stay [25] and new-onset diabetes after AP [26] (Table 1). However, of the 4 studies investigated the predictive value of nomograms for severity or mortality, 3 [17]) and 1 was retrospective [19] in nature.…”

Section: Introductionmentioning

confidence: 99%

A Mobile Terminal-based Nomogram for Early Predicting Severity of Acute Pancreatitis

Shi

Zhang

et al. 2021

Preprint

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Background: Early prediction of the severity of acute pancreatitis (AP) is important but there is no preferred method in China. We aimed to develop and validate a simple-to-use predictive nomogram for persistent organ failure (POF) on admission in patients with AP. Methods: Data from 816 consecutive patients was obtained from internal (Chengdu) retrospective datasets and formed the training cohort for nomogram development. Data from 398 and 880 consecutive patients from internal (Chengdu) and external (Nanchang) prospective datasets formed the validation cohorts (all admitted < 48 hours of symptom onset). Univariate and multivariate logistic regressions were used to identify independent prognostic factors to establish the nomogram for POF. The calibration curves, concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the performance of the nomogram and its clinical utility. The area under the receiver-operating characteristic curve (AUC) with 95% CI and likelihood ratio as well as post-test probability were applied. Measurements and main results: Age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion were identified as independent prognostic factors for POF and were included in the nomogram model (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This predictive nomogram had good predictive ability for POF (C-indexes of 0.88, 0.91 and 0.81 for the training and two validation cohorts) and promising clinical utility (DCA: better or equivalent than prognostic scores; CIC: high clinical net benefit). The AUC of (0.91 [0.88-0.94] and 0.81 [0.79-0.84]), negative likelihood ratio (NLR 0.11 and 0.29), post-test probability of negative (0.9% and 6.7%) of the nomogram were superior in predicting POF than all other routinely used clinical prognostic scoring systems in both validation cohorts. Similar findings were observed for predicting major infection (superior to other prognostic scores) and mortality (superior or equally to others). Conclusions: The validated nomogram comprises 6 independent prognostic factors to predict major clinical outcomes of patients with AP in two distinct Chinese centers. This mobile terminal-based nomogram should be validated in other settings and considered for clinical practice and trial allocation, until more accurate biomarkers are discovered.

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Predictors of outcome of percutaneous catheter drainage in patients with acute pancreatitis having acute fluid collection and development of a predictive model

Cited by 19 publications

References 28 publications

Triple guidance of choledochoscopy, ultrasonography, and computed tomography facilitates percutaneous catheter drainage of infected walled-off necrosis

Triple guidance of choledochoscopy, ultrasonography, and computed tomography facilitates percutaneous catheter drainage of infected walled-off necrosis

Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis

A Mobile Terminal-based Nomogram for Early Predicting Severity of Acute Pancreatitis

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