title: Risk factors and outcome of splanchnic venous thrombosis in patients with necrotizing acute pancreatitis.
abstract: BACKGROUND
  Splanchnic venous thrombosis (SVT) is considered a rare but important complication in patients with acute pancreatitis (AP) and literatures regarding this topic were sparse. The aim of the present study was to investigate the risk factors of SVT in necrotizing acute pancreatitis (NAP) and assess the prognosis of these patients.
  
  
  METHODS
  Both univariate and multivariate logistic regression analyses were applied using 15 indices including age, gender, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), CRP (C - reactive protein) levels, etc to explore potential risk factors for the development of SVT in NAP patients. Moreover, clinical outcome measures such as mortality, organ failure and length of hospital and ICU stay were also compared between NAP patients with or without SVT.
  
  
  RESULTS
  According to the statistical results, only intra-abdominal pressure (IAP) was proved to be an independent risk factor for SVT (OR, 1.283; 95% CI, 1.091-1.509,P=0.003). In addition, Balthazar's CT score and occurrence of IPN (infected pancreatic necrosis) also reached statistical significance (P=0.040 and 0.047, respectively), but the 95% confidence interval shown in the multivariate logistic regression suggested that the observed ORs are not significant (1.326;95% CI 0.984-1.787 and 2.61;95 CI 0.972-7.352, respectively), which indicates weaker association between the two parameters and SVT. Regarding the clinical outcomes, patients with SVT showed higher mortality, longer hospital and intensive care unit duration, higher rates of a variety of complications and more utilization of invasive interventions.
  
  
  CONCLUSIONS
  IAP is an independent risk factor for the development of SVT in patients with NAP, while Balthazar's CT score and occurrence of IPN are also associated with SVT, although not as strong as IAP. Moreover, occurrence of SVT relates with extremely poor prognosis in NAP patients, evidenced by increased mortality, morbidity and need for invasive interventions.
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China.
authors.forename: Lu
authors.initials: L
authors.lastname: Ke
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Tong
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China. Electronic address: njzy_pancrea@163.com.
authors.forename: Weiqin
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Repubic of China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D016017:Odds Ratio; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013152:Splanchnic Circulation; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000628:therapy
keywords: moderate/severe acute pancreatitis; risk factors; splanchnic venous thrombosis