Predictors of outcome of percutaneous catheter drainage in patients with acute pancreatitis having acute fluid collection and development of a predictive model

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2019-07, Vol.19 (5), p.658-664
• Main Authors: Bellam, Balaji L., Samanta, Jayanta, Gupta, Pankaj, Kumar M, Praveen, Sharma, Vishal, Dhaka, Narendra, Sarma, Phulen, Muktesh, Gaurav, Gupta, Vikas, Sinha, Saroj K., Kochhar, Rakesh
• Format: Article
• Language: English
• Subjects: Abdomen; Acute Disease; Acute necrotising pancreatitis; Acute pancreatitis; Adult; Alcohol; Antibiotics; C-reactive protein; Catheters; Computed tomography; Demography; Drainage - adverse effects; Drainage - methods; Endoscopy; Etiology; Female; Humans; Infections; Male; Medical imaging; Middle Aged; Models, Theoretical; Multivariate analysis; Nomogram; Nomograms; Pain; Pancreatitis; Pancreatitis - therapy; Pancreatitis, Acute Necrotizing - therapy; Percutaneous catheter drainage; Physical characteristics; Prediction models; Predictive Value of Tests; Predictors of outcome; Prognosis; Prospective Studies; Sepsis; Studies; Success; Treatment Outcome; Ultrasonic imaging; Wound drainage
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2019.05.467

Percutaneous catheter drainage (PCD) is effective initial strategy in the step-up approach of management of acute pancreatitis (AP). The objective of this study was to identify factors associated with outcomes after PCD and develop a predictive model. In a prospective observational study between July 2016 and Nov 2017, 101 consecutive AP patients were treated using a “step-up approach” in which PCD was used as the first step. We evaluated the association between success of PCD (survival without necrosectomy) and baseline parameters viz. etiology, demography, severity scores, C-reactive protein (CRP), and intra-abdominal pressure (IAP), morphologic characteristics on computed tomography (CT) [percentage of necrosis, CT severity index (CTSI), characteristics of collection prior to PCD (volume, site and solid component of the collection), PCD parameters (initial size, maximum size, number and duration of drainage) and factors after PCD insertion (fall in IAP, reduction in volume of collection). Among 101 patients, 51 required PCD. The success rate of PCD was 66.66% (34/51). Four patients required additional surgical necrosectomy after PCD. Overall mortality was 29.4% (15/51). Multivariate analysis showed percentage of volume reduction of fluid collection (p = 0.016) and organ failure (OF) resolution (p = 0.023) after one week of PCD to be independent predictors of success of PCD. A predictive model based on these two factors resulted in area under curve (AUROC) of 0.915. Nomogram was developed with these two factors to predict the probability of success of PCD. Organ failure resolution and reduction in volume of collection after one week of PCD are significant predictors of successful PCD outcomes in patients with fluid collection following AP