Association analysis of the areas and volume of extrapancreatic necrosis in infected necrotizing pancreatitis with the risk of death

HUANG Dong-ya; LI Qiang; MIAO Yi

doi:10.19538/j.cjps.issn1005-2208.2024.05.16

Abstract：Objective This study aimed to investigate the association between extrapancreatic necrotic areas(ENA)and extrapancreatic necrotic volume(ENV)in infected necrotizing pancreatitis(INP)patients and their mortality rates.Methods A retrospective analysis was conducted on clinical data of 150 patients with INP treated at the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from March 2015 to December 2020.Patients were divided into survival(136 cases)and mortality(14 cases)groups.Logistic regression models,generalized linear models(GLM),and generalized additive models(GAM)were employed to explore the linear and nonlinear relationships between ENA,ENV,and mortality risk.The saturation effect was calculated using a two-piecewise regression model.Results The overall mortality rate was 9.3%(14/150),with a mean patient age of(50.5±15.1)years,and 64.7%(97/150)were male.Univariate analysis showed that the degree of pancreatic parenchymal necrosis,ENV,number of persistent organ failures≥2,upsizing percutaneous catheter drainage(PCD)diameter,and mean computed tomography(CT)density of extrapancreatic necrosis(EN)were positively correlated with mortality risk(P<0.1).After adjusting for confounding variables by introducing or removing covariates that changed the regression coefficient by>10%or had P<0.1 in the univariate analysis,ENA was not associated with mortality risk,while ENV exhibited a nonlinear relationship with mortality risk.The two-piecewise regression analysis identified a turning point at 1250 mL for ENV.On the left side of this threshold,a 100 ml increase in ENV was associated with a 40%higher mortality rate(OR=1.4,95%CI 1.0-2.0,P=0.042).No statistically significant effect was detected on the right side of the turning point(OR=0.7,95%CI 0.4-1.1,P=0.120).Conclusion ENA in INP patients does not correlate with the risk of death,while a nonlinear relationship exists between ENV and mortality rate.Mortality increased with the increase of ENV when ENV is less than 1250 mL.A saturation effect is observed when ENV reaches 1250 mL.