title: Continuous Regional Arterial Infusion of Protease Inhibitors Has No Efficacy in the Treatment of Severe Acute Pancreatitis: A Retrospective Multicenter Cohort Study.
abstract: The aim of this study is to assess the effectiveness of continuous regional arterial infusion (CRAI) of protease inhibitors in patients with severe acute pancreatitis (SAP) including acute necrotizing pancreatitis.
  
  
  
  This retrospective study was conducted among 44 institutions in Japan from 2009 to 2013. Patients 18 years or older diagnosed with SAP according to the criteria of the Japanese Ministry of Health, Labour and Welfare study group (2008) were consecutively enrolled. We evaluated the association between CRAI of protease inhibitors and mortality, incidence of infection, and the need for surgical intervention using multivariable logistic regression analysis.
  
  
  
  Of 1159 patients admitted, 1097 patients with all required data were included for analysis. Three hundred and seventy-four (34.1%) patients underwent CRAI of protease inhibitors and 723 (65.9%) did not. In multivariable analysis, CRAI of protease inhibitors was not associated with a reduction in mortality, infection rate, or need for surgical intervention (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.47-1.32, P = 0.36; OR 0.97, 95% CI 0.61-1.54, P = 0.89; OR 0.76, 95% CI 0.50-1.15, P = 0.19; respectively).
  
  
  
  Continuous regional arterial infusion of protease inhibitors was not efficacious in the treatment of patients with SAP.
authors.affiliation: From the *Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine; †Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center; ‡Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo; §Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama; ∥Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo; ¶Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka; #Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Hiroshima; **The Third Department of Internal Medicine, Kansai Medical University, Osaka; ††Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo; ‡‡Department of General Internal Medicine, Iizuka Hospital, Fukuoka; §§Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo; ∥∥Advanced Emergency Medical and Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma; ¶¶Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa; ##Division of Gastroenterology, Department of Medicine, Showa University School of Medicine; ***Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo; †††Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto;‡‡‡Emergency Medical Center, Fukuyama City Hospital, Hiroshima; §§§Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi; ∥∥∥Department of Traumatology and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba; ¶¶¶Department of Critical Care Medicine, Osaka City University, Osaka; ###Division of Gastroenterology, Tohoku University Hospital, Miyagi; ****Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo; ††††Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu; and ‡‡‡‡Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Horibe
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Sasaki
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Sanui
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugiyama
authors.forename: Eisuke
authors.initials: E
authors.lastname: Iwasaki
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Yamagishi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sawano
authors.forename: Takashi
authors.initials: T
authors.lastname: Goto
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ikeura
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Takuya
authors.initials: T
authors.lastname: Oda
authors.forename: Hideto
authors.initials: H
authors.lastname: Yasuda
authors.forename: Wataru
authors.initials: W
authors.lastname: Shinomiya
authors.forename: Dai
authors.initials: D
authors.lastname: Miyazaki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hirose
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kitamura
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Chiba
authors.forename: Tetsu
authors.initials: T
authors.lastname: Ozaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamashita
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Koinuma
authors.forename: Taku
authors.initials: T
authors.lastname: Oshima
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Morihisa
authors.initials: M
authors.lastname: Hirota
authors.forename: Takashi
authors.initials: T
authors.lastname: Moriya
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shirai
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000188:drug therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy*; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D011480:Protease Inhibitors