Predicting Hospitalization, Organ Dysfunction, and Mortality in Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Are SIRS and qSOFA Reliable Tools?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Selection of Patients
2.2. Procedures and Devices
2.3. Patient Evaluation before and during the Procedure
2.4. Patient Post-ERCP Follow-Up
2.5. Definition of Post-ERCP Complications
2.6. Statistical Analysis and Report of Results
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | All Group (N = 403) | Without PEP (n = 368) | With PEP (n = 35) | p-Value |
---|---|---|---|---|
Age, years, median (quartile) | 66 (55–75) | 66 (54–75) | 68 (59–79) | 0.215 |
Gender, female/male, n (%) | 237/166 (58.8/41.2) | 218/150 (59.2/40.8) | 19/16 (54.3/45.7) | 0.569 |
Environment, urban/rural, n (%) | 226/177 (56.1/43.9) | 210/158 (45.7/54.3) | 16/19 (57.1/42.9) | 0.196 |
Personal history of ERCP procedures | ||||
Personal history of ERCP procedures, n (%) | 81 (20.1) | 79 (21.5) | 2 (2.5) | 0.011 |
Presence of in situ biliary stents, n (%) | 33 (8.2) | 33 (8.97) | 0 (0) | 0.012 |
Type of indication | ||||
urgent/elective, n (%) | 119/284 (29.5/70.5) | 110/258 (29.9/70.1) | 9/26 (25.7/74.3) | 0.597 |
curative/palliative, n (%) | 355/48 (88.1/11.9) | 328/40 (89.1/10.9) | 27/8 (77.1/22.9) | 0.036 |
Anatomy of the major papilla | (N = 322) | (n = 289) | (n = 33) | |
anatomic, n (%) | 168 (52.2) | 150 (51.9) | 18 (54.5) | 0.082 |
Tip I, n (%) | 36 (11.2) | 31 (10.7) | 5 (15.2) | 0.025 |
Tip II, n (%) | 61 (18.9) | 59 (20.4) | 2 (6.1) | 0.001 |
Tip III, n (%) | 32 (9.9) | 31 (10.7) | 1 (3) | 0.001 |
Tip IV, n (%) | 25 (7.8) | 18 (6.2) | 7 (21.2) | 0.001 |
Duodenal diverticula, n (%) | ||||
Absent | 352 (87.3) | 320 (87) | 32 (91.4) | 0.425 |
Tip 1 | 8 (2) | 8 (2.2) | 0 (0) | 0.067 |
Tip 2 | 32 (7.9) | 30 (8.2) | 2 (5.7) | 0.092 |
Tip 3 | 11 (2.7) | 10 (2.7) | 1 (2.9) | 0.846 |
ASA classification, n (%) | ||||
1 | 236 (58.6) | 217 (59) | 19 (54.3) | 0.461 |
2 | 138 (34.2) | 127 (34.5) | 11 (31.4) | 0.537 |
3 | 21 (5.2) | 16 (4.3) | 5 (14.3) | 0.064 |
4 | 8 (2) | 8 (2.2) | 0 (0) | 0.077 |
Cannulation, easy/difficult, n (%) | 285/118 (70.7/29.3) | 271/97 (73.6/26.4) | 14/21 (40/60) | <0.001 |
Number of cannulation attempts, ≤5/>5, n (%) | 316/87 (78.4/21.6) | 295/73 (80.2/19.8) | 21/14 (60/40) | 0.009 |
Cannulation time: <5 min/≥5 min, n (%) | 337/66 (83.6/16.4) | 316/52 (85.9/14.1) | 21/14 (60/40) | <0.001 |
Type of cannulation | ||||
Wirsung cannulation, n (%) | 73 (18.1) | 60 (16.3) | 13 (37.1) | 0.005 |
CBP cannulation CBP, n (%) | 365 (90.6) | 333 (90.5) | 32 (91.4) | 0.903 |
Guide wire cannulation, n (%) | 363 (90.1) | 329 (89.4) | 34 (97.1) | 0.242 |
SC cannulation, n (%) | 10 (2.5) | 9 (2.4) | 1 (2.9) | 0.675 |
Selective cannulation, n (%) | 346 (85.9) | 316 (85.9) | 30 (85.7) | 0.819 |
Sphincterotomy | ||||
Without sphincterotomy, n (%) | 91 (22.9) | 88 (23.9) | 3 (8.6) | 0.021 |
Partial biliary sphincterotomy, n (%) | 134 (33.3) | 120 (32.3) | 14 (40) | 0.053 |
Total biliary sphincterotomy, n (%) | 178 (44.2) | 160 (43.5) | 18 (51.4) | 0.089 |
Needle knife precut, n (%) | 25 (6.2) | 17 (4.6) | 8 (22.9) | 0.002 |
Needle lnife fistulotomy, n (%) | 4 (1) | 4 (1.1) | 0 (0) | 0.163 |
Trans-pancreatic, n (%) | 10 (2.5) | 9 (2.4) | 1 (2.9) | 0.841 |
SIRS | 66 (16.4) | 54 (14.7) | 12 (34.3) | 0.002 |
With suspicion of organ dysfunction (qSOFA) | 48 (11.9) | 39 (10.6) | 9 (25.7) | 0.008 |
qSOFA 1 | 27 (6.7) | 23 (6.3) | 4 (11.4) | 0.017 |
qSOFA 2 | 12 (3) | 9 (2.5) | 3 (8.6) | 0.018 |
qSOFA 3 | 9 (2.2) | 7 (1.9) | 2 (5.7) | 0.014 |
Organ dysfunction | 40 (9.9) | 32 (8.7) | 8 (22.9) | 0.007 |
one dysfunction | 35 (8.7) | 29 (7.9) | 6 (17.1) | <0.001 |
two dysfunctions | 3 (0.7) | 3 (0.8) | 0 (0) | 0.154 |
three dysfunctions | 2 (0.5) | 0 (0) | 2 (5.7) | 0.003 |
Duration of hospitalization, days, median (quartile) | 11 (7–17) | 11 (7–17) | 13 (10–22) | 0.007 |
Patients (n = 403) | Complications | PEP | Bleeding | Infection | Perforation |
---|---|---|---|---|---|
n (%) | 77 (19.11) | 35 (8.68) | 12 (2.98) | 36 (8.93) | 3 (0.74) |
PEP | Bleeding | Infection | Total | |||
---|---|---|---|---|---|---|
Absent | Present | |||||
Absent | Absent | 327 | 81.14% | 31 | 7.69% | 358 |
Present | 9 | 2.23% | 1 | 0.25% | 10 | |
Present | Absent | 29 | 7.20% | 4 | 0.99% | 33 |
Present | 2 | 0.50% | 0 | 0.00% | 2 |
Time Interval of Follow-Up | PEP Patients | Non-PEP Patients |
---|---|---|
(Days) | Survival Rate (%) | |
7 | 100 | 100 |
13 | 97.1429 | 98.0978 |
19 | 88.5714 | 97.0109 |
25 | 88.5714 | 96.7391 |
31 | 88.5714 | 96.7391 |
37 | 88.5714 | 96.1957 |
43 | 88.5714 | 95.9239 |
49 | 85.7143 | 94.5652 |
55 | 85.7143 | 94.2935 |
61 | 82.8572 | 93.2065 |
Log-rank test | WW = −3.422; Sum = 30.853; Var = 2.4529 Test = −2.18516 | p = 0.02888 |
PEP Present | |||||
---|---|---|---|---|---|
AUC | Standard Error | p-Value | AUC—95% CI | ||
Lower Limit | Upper Limit | ||||
Organ dysfunction | |||||
SIRS | 0.926 | 0.044 | 0.000 | 0.839 | 1.000 |
SOFA | 0.993 | 0.010 | 0.000 | 0.973 | 1.000 |
Survival | |||||
SIRS | 0.796 | 0.101 | 0.024 | 0.598 | 0.994 |
SOFA | 0.885 | 0.097 | 0.003 | 0.696 | 1.000 |
Length of stay | |||||
SIRS | 0.506 | 0.113 | 0.955 | 0.285 | 0.728 |
SOFA | 0.466 | 0.112 | 0.763 | 0.247 | 0.685 |
PEP absent | |||||
Organ dysfunction | |||||
SIRS | 0.916 | 0.031 | 0.000 | 0.855 | 0.977 |
SOFA | 0.977 | 0.018 | 0.000 | 0.941 | 1.000 |
Survival | |||||
SIRS | 0.808 | 0.054 | 0.000 | 0.702 | 0.913 |
SOFA | 0.860 | 0.052 | 0.000 | 0.759 | 0.962 |
Length of stay | |||||
SIRS | 0.558 | 0.030 | 0.053 | 0.500 | 0.617 |
SOFA | 0.546 | 0.030 | 0.131 | 0.487 | 0.604 |
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Balan, G.G.; Timofte, O.; Gilca-Blanariu, G.-E.; Sfarti, C.; Diaconescu, S.; Gimiga, N.; Antighin, S.P.; Sandu, I.; Sandru, V.; Trifan, A.; et al. Predicting Hospitalization, Organ Dysfunction, and Mortality in Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Are SIRS and qSOFA Reliable Tools? Appl. Sci. 2023, 13, 6650. https://doi.org/10.3390/app13116650
Balan GG, Timofte O, Gilca-Blanariu G-E, Sfarti C, Diaconescu S, Gimiga N, Antighin SP, Sandu I, Sandru V, Trifan A, et al. Predicting Hospitalization, Organ Dysfunction, and Mortality in Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Are SIRS and qSOFA Reliable Tools? Applied Sciences. 2023; 13(11):6650. https://doi.org/10.3390/app13116650
Chicago/Turabian StyleBalan, Gheorghe Gh., Oana Timofte, Georgiana-Emmanuela Gilca-Blanariu, Catalin Sfarti, Smaranda Diaconescu, Nicoleta Gimiga, Simona Petronela Antighin, Ion Sandu, Vasile Sandru, Anca Trifan, and et al. 2023. "Predicting Hospitalization, Organ Dysfunction, and Mortality in Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Are SIRS and qSOFA Reliable Tools?" Applied Sciences 13, no. 11: 6650. https://doi.org/10.3390/app13116650
APA StyleBalan, G. G., Timofte, O., Gilca-Blanariu, G.-E., Sfarti, C., Diaconescu, S., Gimiga, N., Antighin, S. P., Sandu, I., Sandru, V., Trifan, A., Moscalu, M., & Stefanescu, G. (2023). Predicting Hospitalization, Organ Dysfunction, and Mortality in Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Are SIRS and qSOFA Reliable Tools? Applied Sciences, 13(11), 6650. https://doi.org/10.3390/app13116650