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Early-onset emphysematous pancreatitis indicates poor outcomes in patients with infected pancreatic necrosis

  • Jiarong Li
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
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  • Chiayen Lin
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
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  • Caihong Ning
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
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  • Qin Wei
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
    Search for articles by this author
  • Lu Chen
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
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  • Shuai Zhu
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
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  • Dingcheng Shen
    Correspondence
    Corresponding authors at: Department of Pancreatic Surgery, General Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China.
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
    Search for articles by this author
  • Gengwen Huang
    Correspondence
    Corresponding authors at: Department of Pancreatic Surgery, General Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China.
    Affiliations
    Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
    Search for articles by this author
Published:April 18, 2022DOI:https://doi.org/10.1016/j.dld.2022.04.001

      Abstract

      Background

      Emphysematous pancreatitis (EP) is a subtype of infected pancreatic necrosis (IPN) characterized by presence of gas in (peri)pancreatic necrosis. However, the impacts of EP on outcomes of IPN are still controversial.

      Methods

      A prospective database of consecutive patients with IPN in a tertiary hospital was post-hoc analyzed. Patients were assigned to EP and non-EP groups to perform a comprehensive comparison.

      Results

      A total of 178 patients with IPN were enrolled and the overall mortality was 30.9%. EP accounted for 20.8% (n = 37) of cases and was significantly associated with higher incidences of Escherichia coli (45.9 versus 18.4%, P = 0.001) and Klebsiella pneumoniae (56.8 versus 33.3%, P = 0.009) infection. There was scarcely any disparity in clinical characteristics and outcomes between IPN patients with and without EP. However, patients with early-onset EP defined as air bubble signs occurring within 2 weeks from disease onset were significantly older and have higher prevalence of history of diabetes, and they were also associated with significantly higher mortality (57.1 versus 8.7%, P = 0.015) compared with late-onset patients.

      Conclusions

      The clinical outcomes of EP might be like those of non-emphysematous infection. However, when EP occurs within 2 weeks from disease onset, it is highly lethal.

      Keywords

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