Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis

To assess the association between the clinical parameters within 48hours of admission and the occurrence of infected pancreatic necrosis (IPN) during the late phase of necrotizing pancreatitis (NP). All patients were divided into 2 groups, the IPN and non-IPN groups. The clinical data were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between clinical parameters and IPN secondary to NP. The performance of each independent variable was plotted by the receiver-operating characteristic (ROC) curve. Consequently, the cut-off level of each independent variable with its sensitivity and specificity was calculated. A total of 215 patients were enrolled in our study. Among them, 87 (40.5%) patients developed IPNs after a median of 13.5 (9.5-23.0) days from admission. Multivariate analysis indicated that the level of hematocrit (HCT) from 40% to 50% (P=.012, odds ratio (OR)=2.407), HCT over 50% (P<.009, OR=6.794), blood urea nitrogen (BUN) (P=.040, OR=1.894), C-reactive protein (CRP) (P=.043, OR=1.837), and procalcitonin (PCT) (P=.002, OR=2.559) were independent risk factors of IPN secondary to NP. The ROC cures revealed that the area under the ROC (AUC) of the maximum level of HCT, BUN, CRP, and PCT within 48hours of admission was 0.687, 0.620, 0.630, and 0.674 respectively. Furthermore, the combination of these 4 individual parameters contributes to a more preferable AUC of 0.789 with a sensitivity of 67.8% and specificity of 77.3%. The maximum levels of PCT, CRP, HCT, and BUN within 48hours of admission are independent factors of IPN and their combination might accurately predict the occurrence of IPN secondary to NP. Abbreviations: APACHE = acute physiology and chronic health evaluation, AUC = area under the ROC, BMI = body mass index, BUN = blood urea nitrogen, Cr = creatinine, CRP = C-reactive protein, CT = computed tomography, CTSI = computed tomography severity index, HCT = hematocrit, ICU = intensive care unit, IPN = infected pancreatic necrosis, MSAP = moderate serve acute pancreatitis, OR = odds ratio, PCD = percutaneous catheter drainage, PCT = procalcitonin, PLT = platelet, ROC = receiveroperating characteristic curve, SAP = severe acute pancreatitis, SOFA = sequential organ failure assessment, WBC = white blood cell.