title: Predictors of percutaneous catheter drainage (PCD) after abdominal paracentesis drainage (APD) in patients with moderately severe or severe acute pancreatitis along with fluid collections.
abstract: OBJECTIVE
  Although we previously demonstrated abdominal paracentesis drainage (APD) preceding percutaneous catheter drainage (PCD) as the central step for treating patients with moderately severe (MSAP) or severe acute pancreatitis (SAP), the predictors leading to PCD after APD have not been studied.
  
  
  METHODS
  Consecutive patients with MSAP or SAP were recruited between June 2011 and June 2013. As a step-up approach, all patients initially received medical management, later underwent ultrasound-guided APD before PCD, if necessary, followed by endoscopic necrosectomy through the path formed by PCD. APD primarily targeted fluid in the abdominal or pelvic cavities, whereas PCD aimed at (peri)pancreatic fluid.
  
  
  RESULTS
  Of the 92 enrolled patients, 40 were managed with APD alone and 52 received PCD after APD (14 required necrosectomy after initial PCD). The overall mortality was 6.5%. Univariate analysis showed that among the 20 selected parameters, 13 factors significantly affected PCD intervention after APD. Multivariate analysis revealed that infected (peri)pancreatic collections (P = -0.001), maximum extent of necrosis of more than 30% of the pancreas (P = -0.024), size of the largest necrotic peri(pancreatic) collection (P = -0.007), and reduction of (peri)pancreatic fluid collections by <50% after APD (P = -0.008) were all independent predictors of PCD.
  
  
  CONCLUSIONS
  Infected (peri)pancreatic collections, a largest necrotic peri(pancreatic) collection of more than 100 ml, and reduction of (peri)pancreatic fluid collections by <50% after APD could effectively predict the need for PCD in the early course of the disease.
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Wei-hui
authors: WH
authors: Liu
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Tao
authors: T
authors: Wang
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Hong-tao
authors: HT
authors: Yan
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Tao
authors: T
authors: Chen
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Chuan
authors: C
authors: Xu
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Ping
authors: P
authors: Ye
authors: General Surgery Center, Xijing Hospital, Xi'an, Shanxi Province, 710032, China.
authors: Ning
authors: N
authors: Zhang
authors: General Surgery Center, Xijing Hospital, Xi'an, Shanxi Province, 710032, China.
authors: Zheng-cai
authors: ZC
authors: Liu
authors: General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China.
authors: Li-jun
authors: LJ
authors: Tang
mesh_terms: D034841:Abdominal Cavity; D000208:Acute Disease; D000328:Adult; D002404:Catheterization; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D019152:Paracentesis; D012720:Severity of Illness Index; D015996:Survival Rate; D014463:Ultrasonography