title: Intra-Abdominal Pressure Reduction After Percutaneous Catheter Drainage Is a Protective Factor for Severe Pancreatitis Patients With Sterile Fluid Collections.
abstract: OBJECTIVE
  Severe acute pancreatitis (SAP) is a fatal disease with natural course of early SAP (ESAP) and late SAP (LSAP) phases. Peripancreatic percutaneous catheter drainage (PCD) is effective in management of LSAP. Although our previous study indicates that intra-abdominal PCD ahead of peripancreatic PCD benefits ESAP patients with sterile fluid collections, the mechanism is still uncovered.
  
  
  METHODS
  According to therapeutic results, 452 SAP patients who underwent PCD were divided into sterile group (248 cases), secondary infection group (145 cases), and primary infection group (59 cases).
  
  
  RESULTS
  The mortality was 4.1%, 10.9%, and 18.6%, respectively. Logistic-regression analysis indicated that multiorgan dysfunction syndrome (odds ratio [OR], 1.717; 95% confidence interval [95% CI], 1.098-2.685; P = 0.018), catheters located intra-abdominally (OR, 0.511; 95% CI, 0.296-0.884; P = 0.016), and intra-abdominal hypertension (OR, 1.534; 95% CI, 1.016-2.316; P = 0.042) were predictors for infection after PCD. Receiver operating characteristics curve delineated that decrease of intra-abdominal pressure (IAP) of more than 6.5 mm Hg after PCD had the ability to predict infection with sensitivity of 84.0% and specificity of 79.5%.
  
  
  CONCLUSIONS
  Intra-abdominal PCD for acute sterile fluid collections seems to be an effective option rather than peripancreatic PCD. Patients with a significant decrease of IAP had a lower incidence of infection and better alleviation of organ failure.
authors.affiliation: From the*General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province; †Department of Vascular and Endocrine Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province; ‡Department of Urology Surgery, Chengdu Military General Hospital, Chengdu, Sichuan Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Li-ye
authors.initials: LY
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Luo
authors.forename: Rui-wu
authors.initials: RW
authors.lastname: Dai
authors.forename: Hong-yin
authors.initials: HY
authors.lastname: Liang
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.forename: Hong-tao
authors.initials: HT
authors.lastname: Yan
authors.forename: Jian-feng
authors.initials: JF
authors.lastname: Cui
authors.forename: Nan-lin
authors.initials: NL
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Wei-hui
authors.initials: WH
authors.lastname: Liu
authors.forename: Li-jun
authors.initials: LJ
authors.lastname: Tang
mesh_terms: D000208:Acute Disease; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057785:Catheters; D016009:Chi-Square Distribution; D002681:China; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D011312:Pressure; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome