Parecoxib reduces extrapancreatic infections in non-mild hypertriglyceridemia-induced acute pancreatitis patients during hospitalization

Huang Xiaodong; Huang Xianwei; Liu Siyao; Xu Zhihong; Liu Xiong; Zheng Qingliu; Hu Jun; Lin Jiyan

doi:10.3969/j.issn.1002-1949.2024.12.011

Abstract：Objective To evaluate the impact of early parecoxib treatment on clinical outcomes during hospitalization,including mortality,organ failure,local complications and pancreatic and extrapancreatic infections,in the patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP).Methods We conducted a retrospective cohort analysis on401 HTG-AP patients hospitalized in the First Affiliated Hospital of Xiamen University from January 1,2018 to December 31,2023.Patients were classified into mild group (n=266 ) and non-mild group (n=135 ) based on clinical severity.Additionally,they were divided into parecoxib group(n=221) and conventional group(n=45) based on whether parecoxib was used within 24 h after admission.The basic information,laboratory indicators and clinical outcomes of the two groups were compared.Survival analysis was performed by using the Kaplan-Meier method,and survival curves were plotted.Cox regression analysis was used to assess the impact of parecoxib use and other factors on clinical outcomes.Propensity score matching (PSM ) was used to balance baseline differences between the two groups to further validate the comparison results.Results The use of parecoxib did not significantly affect major clinical outcomes,such as mortality,organ failure and local complications,in HTG-AP patients during hospitalization.However,early use of parecoxib significantly reduced the risk of extrapancreatic infection (30.19％ vs.63.41％,P<0.001 ) and shortened the time of abdominal pain relief[d:1(1,2) vs.2(1,3),P<0.001]in non-mild patients.Kaplan-Meier curve analysis showed that the cumulative incidence of extrapancreatic infection in the parecoxib group was significantly lower than that in the conventional group among non-mild HTG-AP patients(P<0.05).Multivariate Cox regression analysis revealed that early use of parecoxib (HR=0.45,95％CI 0.24-0.84,P<0.05) was an independent protective factor in reducing extrapancreatic infection in non-mild HTG-AP patients.After PSM adjustment,it was further confirmed that early use of parecoxib reduced extrapancreatic infection during hospitalization(32.14％ vs.58.54％,P=0.031) and accelerated the relief of abdominal pain[d:1.00(0.25,2.00) vs.2.00(1.00,3.00),P<0.001]in the patients with non-mild HTG-AP (P<0.05).Conclusions For the patients with non-mild HTG-AP,early administration of parecoxib effectively reduces the risk of extrapancreatic infection during hospitalization and shortens the time of abdominal pain relief.