Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
Authors: Podda Mauro , Pellino Gianluca , Di Saverio Salomone , Coccolini Federico , Pacella Daniela , Cioffi Stefano Piero Bernardo , Virdis Francesco , Balla Andrea , Ielpo Benedetto , Pata Francesco , Poillucci Gaetano , Ortenzi Monica , Damaskos Dimitrios , De Simone Belinda , Sartelli Massimo , Leppaniemi Ari , Jayant Kumar , Catena Fausto , Giuliani Antonio , Di Martino Marcello , Pisanu Adolfo ,   the MANCTRA-1 Collaborative Group, Gerardi Chiara , Gourgiotis Stavros , Riboni Cristiana , Giordano Alessio , Ferrario Luca , Agnoletti Vanni , Kruger Yoram , Mole Damian , Agresta Ferdinando , Prieto Calvo Mikel , Wilson Michael , Soggiu Fiammetta , Hamdan Alaa , Gomes Carlos Augusto , Fraga Gustavo , Ioannidis Argyrios , Demetrashvili Zaza , Sahani Saaz , Bains Lovenish , Khamees Almu’atasim , Ababneh Hazim , Aljaiuossi Osama , Pimentel Samuel , Mohamad Ikhwan Sani , Yusoff Ahmad Ramzi , Zarnescu Narcis Octavian , Calu Valentin , Litvin Andrey , Lesko Dusan , Elmehrath Ahmed , Elshami Mohamedraed , de Santibañes Martin , Gundara Justin , Alawadhi Kamel , Lui Rashid , Julianov Alexander , Ralon Sergio , Garzali Ibrahim-Umar , Machain Gustavo M , Villalabeitia Ibabe , Quispe-Cruz Darwin Artidoro , Orantia Abigail Cheska C. , Walędziak Maciej , de Sá Tiago Correia , Ali Syed Muhammad , Kovacevic Bojan , Noel Colin , Abdalah Haidar M. , Kchaou Ali , Isik Arda , Ansaloni Luca , Biffl Walter , Guerrieri Mario , Sartori Alberto , Abradelo Manuel , Nigri Giuseppe , Di Lorenzo Nicola , Mingoli Andrea , Chiarugi Massimo , Di Menno Stavron Juliana , Mazza Oscar , Valenzuela José Ignacio , Pachajoa Diana Alejandra Pantoja , Alvarez Fernando Andrés , Liaño Julian Ezequiel , Tefay Joan , Alshaikh Abdulrahman , Hasan Layla , Couto Gomes Felipe , Calderan Thiago R. A. , Hirano Elcio S. , Dardanov Dragomir , Julianov Alexander , Saroglu Azize , Atanasov Boyko , Belev Nikolay , Kovachev Nikola , Chan Shannon Melissa , Lok Hon-Ting , Salcedo Diego , Robayo Diana , Triviño María Alejandra , Manak Jan , Sahani Saaz , de Araujo Jorann , Sethi Ananya , Awad Ahmed , Elbadawy Merihan , Farid Ahmed , Hanafy Asmaa , Nafea Ahmed , Sherief Ghozy , Salah Alzhraa Abbas , Abdelsalam Wafaa , Emile Sameh , Elfallal Ahmed , Elfeki Hossam , Elghadban Hosam , Shoma Ashraf , Shetiwy Mohamed , Elbahnasawy Mohamed , Mohamed Salem , Hamed Emad Fawzi , Khalil Usama Ahmed , Chouillard Elie , Gumbs Andrew , Police Andrea , Mabilia Andrea , Khutsishvili Kakhi , Tvaladze Anano , Ioannidis Orestis , Anestiadou Elissavet , Loutzidou Lydia , Konstantinidis Konstantinis , Konstantinidou Sofia , Manatakis Dimitrios , Acheimastos Vasileios , Tasis Nikolaos , Michalopoulos Nikolaos , Kokoropoulos Panagiotis , Papadoliopoulou Maria , Sotiropoulou Maria , Kapiris Stylianos , Metaxas Panagiotis , Tsouknidas Ioannis , Kefili Despoina , Petrakis George , Synekidou Eirini , Dakis Konstantinos , Alexandridou Eirini , Papadopoulos Aristeidis , Chouliaras Christos , Mouzakis Odysseas , Mulita Francesk , Maroulis Ioannis , Vailas Michail , Triantafyllou Tania , Theodorou Dimitrios , Lostoridis Eftychios , Nagorni Eleni-Aikaterini , Tourountzi Paraskevi , Baili Efstratia , Charalabopoulos Alexandros , Liakakos Theodore , Schizas Dimitrios , Kozadinos Alexandros , Syllaios Athanasios , Machairas Nikolaos , Kykalos Stylianos , Stamopoulos Paraskevas , Delis Spiros , Farazi-Chongouki Christos , Kalaitzakis Evangelos , Giannarakis Miltiadis , Lasithiotakis Konstantinos , Petra Giorgia , Kalaitzakis Evangelos , Gupta Amit , Medappil Noushif , Muthukrishnan Vijayanand , Kamar Jubin , Lal Pawan , Agarwal Rajendra , Magnoli Matteo , Aonzo Paolo , Serventi Alberto , Di Lascio Pierpaolo , Pinto Margherita , Bergamini Carlo , Bottari Andrea , Fortuna Laura , Martellucci Jacopo , Cicako Atea , Miglietta Claudio , Morino Mario , Delogu Daniele , Picchetto Andrea , Assenza Marco , D’Ambrosio Giancarlo , Argenio Giulio , Armellino Mariano Fortunato , Ioia Giovanna , Occhionorelli Savino , Andreotti Dario , Domenico Lacavalla , Luppi Davide , Casadei Massimiliano , Di Donato Luca , Manoochehri Farshad , Marchese Tiziana Rita Lucia , Sergi William , Manca Roberto , Murgia Raimondo , Piras Enrico , Conti Lorenzo , Gianazza Simone , Rizzi Andrea , Segalini Edoardo , Monti Marco , Iiritano Elena , Mariani Nicolò Maria , De Nicola Enrico , Scifo Giovanna , Pignata Giusto , Andreuccetti Jacopo , Fleres Francesco , Clarizia Guglielmo , Spolini Alessandro , Biloslavo Alan , Germani Paola , Mastronardi Manuela , Bogoni Selene , Palmisano Silvia , De Manzini Nicolo’ , Marino Marco Vito , Martines Gennaro , Trigiante Giuseppe , Lagouvardou Elpiniki , Anania Gabriele , Bombardini Cristina , Oppici Dario , Pilia Tiziana , Murzi Valentina , Gessa Emanuela , Bracale Umberto , Di Nuzzo Maria Michela , Peltrini Roberto , Salvetti Francesco , Viganò Jacopo , Sganga Gabriele , Bianchi Valentina , Fransvea Pietro , Fontana Tommaso , Sarro Giuliano , Dinuzzi Vincenza Paola , Scaravilli Luca , Papa Mario Virgilio , Jovine Elio , Ciabatti Giulia , Mastrangelo Laura , Rottoli Matteo , Ricci Claudio , Russo Iris Shari , Aiolfi Alberto , Bona Davide , Lombardo Francesca , Cianci Pasquale , Sederino Mariagrazia , Bini Roberto , Chiara Osvaldo , Cioffi Stefano , Cantafio Stefano , Coretti Guido , Licitra Edelweiss , Savino Grazia , Grimaldi Sergio , Porfidia Raffaele , Moggia Elisabetta , Garino Mauro , Marafante Chiara , Pesce Antonio , Fabbri Nicolò , Feo Carlo Vittorio , Marra Ester , Troian Marina , Drigo Davide , Nagliati Carlo , Muratore Andrea , Danna Riccardo , Murgese Alessandra , Crespi Michele , Guerci Claudio , Frontali Alice , Ferrari Luca , Guerci Claudio , Favi Francesco , Picariello Erika , Rampini Alessia , D’Acapito Fabrizio , Ercolani Giorgio , Solaini Leonardo , Palmieri Francesco , Calì Matteo , Ferrara Francesco , Muttillo Irnerio Angelo , Muttillo Edoardo Maria , Picardi Biagio , Galleano Raffaele , Badran Ali , Ghazouani Omar , Cervellera Maurizio , Campanella Gaetano , Papa Gennaro , Di Bella Annamaria , Perrone Gennaro , Petracca Gabriele Luciano , Prioriello Concetta , Giuffrida Mario , Cozzani Federico , Rossini Matteo , Inama Marco , Butturini Giovanni , Moretto Gianluigi , Morelli Luca , Candio Giulio , Guadagni Simone , Cicuttin Enrico , Cremonini Camilla , Tartaglia Dario , Genovese Valerio , Cillara Nicola , Cannavera Alessandro , Deserra Antonello , Picciariello Arcangelo , Papagni Vincenzo , Vincenti Leonardo , Bagaglini Giulia , Sica Giuseppe , Lapolla Pierfrancesco , Brachini Gioia , Bono Dario , Nicotera Antonella , Zago Marcello , Sammartano Fabrizio , Benuzzi Laura , Stella Marco , Rossi Stefano , Cerioli Alessandra , Puccioni Caterina , Olmi Stefano , Rubicondo Carolina , Uccelli Matteo , Guida Anna , Lepiane Pasquale , Sasia Diego , Giraudo Giorgio , Salomone Sara , Belloni Elena , Cossa Alessandra , Lancellotti Francesco , Caronna Roberto , Chirletti Piero , Saullo Paolina , Troiano Raffaele , Mucilli Felice , Barone Mirko , Ippoliti Massimo , Grande Michele , Sensi Bruno , Siragusa Leandro , Santini Andrea , Di Carlo Isidoro , Veroux Massimiliano , Gioco Rossella , Veroux Gastone , Currò Giuseppe , Ammendola Michele , Komaei Iman , Navarra Giuseppe , Tonini Valeria , Sartarelli Lodovico , Ceresoli Marco , Perrone Stefano , Roccamatisi Linda , Millo Paolo , Brachet Contul Riccardo , Ponte Elisa , Zuin Matteo , Portale Giuseppe , Tonello Alice Sabrina , Fratini Geri , Bianchini Matteo , Perotti Bruno , Doria Emanuele , Lunghi Elia Giuseppe , Visconti Diego , Al-Shami Khayry , Awadi Sajeda , Buwaitel Mohammad Musallam Khalil , Naffa’ Mo’taz Fawzat Naief , Samhouri Ahmad , Sawalha Hatem , Ani Mohd Firdaus Che , Fathil Ida Nadiah Ahmed , Huei Jih , Mohamad Ikhwan Sani , Beristain-Hernandez Jose-Luis , Garcia-Meza Alejandro , Sepulveda-Rdriguez Rafael , Hernández Edgard Efren Lozada , Pinzón Camilo Levi Acuña , Condoy Jefferson Nieves , García Francisco C. Becerra , Sadik Mohammad , Kadir Bushra , Devi Jalpa , Seerani Nandlal , Zainab  , Sohail-Asghar Mohammad , Afzal Ameer , Akbar Ali , Lohse Helmut Segovia , Lohse Herald Segovia , Cabrera Zamiara Solange Leon , Seto Gaby Susana Yamamoto , Chiuyari José Ríos , Ordemar Jorge , Rodríguez Martha , Orantia-Carlos Abigail Cheska C. , Quitoy Margie Antionette , Kwiatkowski Andrzej , Mawlichanów Maciej , Rocha Mónica , Soares Carlos , Stoian Alexandru Rares , Draghici Andreea Diana , Grigorean Valentin Titus , Radulescu Raluca Bievel , Zarnescu Narcis Octavian , Costea Radu Virgil , Zarnescu Eugenia Claudia , Kurtenkov Mikhail , Gendrikson George , Alla-Angelina Volovich , Arina Tsurbanova , Kaldarov Ayrat , Kaldarov Ayrat , Gachabayov Mahir , Abdullaev Abakar , Milentijevic Milica , Karamarkovic Milovan , Panyko Arpád , Radonak Jozef , Soltes Marek , Morán Laura Álvarez , García Haydée Calvo , Vega Pilar Suárez , Estevez Sergio , Ausania Fabio , Farguell Jordi , González-Abós Carolina , Sánchez-Cabús Santiago , Martín Belén , Molina Víctor , Oms Luis , Ilzarbe Lucas , Feijóo Eva Pont , Perra Elena Sofia , Rojas-Bonet Noel , Penalba-Palmí Rafael , Pérez-Bru Susana , Tur-Martínez Jaume , Álvarez-Torrado Andrea , Domingo-Gonzalez Marta , Tejedor-Tejada Javier , del Alamo Yaiza García , Mendoza-Moreno Fernando , García-Moreno-Nisa Francisca , Matías-García Belén , Durán Manuel , Calleja-Lozano Rafael , de Villar José Manuel Perez , Sánchez-Guillén Luis , Caravaca Iban , Triguero-Cánovas Daniel , Aparicio Antonio Carlos Maya , Meléndez Blas Durán , Palacios Andrea Masiá , Landaluce-Olavarria Aitor , De Francisco Mario , Estraviz-Mateos Begoña , Alconchel Felipe , Nicolás-López Tatiana , Ramírez Pablo , Muñoz-Cruzado Virginia Duran , Ciuró Felipe Parej , del Pozo Eduardo Perea , Pizarro Sergio Olivares , Cabrera Vicente Herrera , Bayo Jose Muros , Hamid Hytham K. S. , Roesel Raffaello , Cristaudi Alessandra , Abbas Kinan , Ali Iyad , Tlili Ahmed , Bayhan Hüseyin , Türkoğlu Mehmet Akif , Uzunoglu Mustafa Yener , Azamat Ibrahim Fethi , Omarov Nail , Uymaz Derya Salim , Altintoprak Fatih , Akin Emrah , First Necattin , Das Koray , Ozer Nazmi , Seker Ahmet , Kara Yasin , Bozkurt Mehmet Abdussamet , Kocataş Ali , Atici Semra Demirli , Akalin Murat , Calik Bulent , Colak Elif , Altinel Yuksel , Meric Serhat , Aktimur Yunus Emre , Hudson Victoria , Duval Jean-Luc , Khan Mansoor , Saad Ahmed , Kaur Mandeep , Bradley Alison , Fox Katherine , Tomasi Ivan , Beasley Daniel , Prasanti Alekhya Kotta , Kotecha Pinky , Ebied Husam , Paul Michaela , Sheth Hemant , Gerogiannis Ioannis , Gaber Mohannad , Sheikh Zara , Seth Shatadru , Kunitsyna Maria , Leo Cosimo Alex , Bellato Vittoria , Zafar Noman , Elserafy Amr , Bond-smith Giles , Tebala Giovanni , Mathur Pawan , Abid Izza , Chidumije Nnaemeka , Sandhar Pardip , Ullah Syed Osama Zohaib , Lezama Tamara , Anwaar Muhammad Hassan , Magee Conor , Ahmed Salma , Davies Brooke , Apollos Jeyakumar , McCormack Kieran , Choudhary Hasham , Doulias Triantafyllos , Morrison Tamsin , Palepa Anna , Cal Fernando Bonilla , Sánchez Lianet , Domínguez Fabiana , Al-Raimi Ibrahim , Alshargabi Haneen , Meead Abdullah , Chooklin Serge , Chuklin Serhii , Bilyak Andriy 
Published: March 2023

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990).

Graphical abstract