Discussion
obesity, comorbidity, cholangitis, organ failure, necrosis, infection of pancreatic necrosis, pancreatic necrosis, diabetes
OBESITY, MULTIPLE ORGAN FAILURE, CHOLANGITIS, DISEASE COURSE, DISEASE, ABDOMINAL COMPARTMENT SYNDROME, NECROSIS, ARTERIAL HYPERTENSION, PANCREATIC NECROSIS, DIABETES
In this post hoc analysis of the MANCTRA-1 study, we have shown that the adverse outcomes in patients with IPN are related to two separate groups of factors. On the one hand, we found factors related to the disease course and its severity, such as organ failure, acute cholangitis, and abdominal compartment syndrome, or to the patient’s comorbidity, such as obesity, diabetes, and uncontrolled arterial hypertension. On the other, we found modifiable factors related to patient management. In particular, when the current guidelines and recommendations are not followed, for example, in the cases of upfront open surgical necrosectomy or when nutritional support is provided via total parenteral nutrition instead of enteral nutrition.While in previous studies [Although patient-specific risk algorithms have been implemented in previous studies with evidence of benefit in improving the prediction of patient outcomes, it is still undetermined what factors can impact the survival once infection of pancreatic necrosis has been established [Previous studies focusing on patients with IPN found that multiple organ failure, long duration (≥ 5 days) of organ failure, and open necrosectomy performed outside a step-up approach were associated with high mortality rates [IPN is a disease that mandates individual patient evaluation in a multidisciplinary setting in collaboration among gastroenterologists, surgeons, endoscopists, intensive care physicians, and interventional radiologists, to adequately evaluate patients’ suitability for different available interventions and treatment options. Guidelines recommend that interventional strategies in patients with pancreatic necrosis should be delayed until necrosis is well demarcated [Finally, the findings of our study proved that enteral nutrition significantly reduced the risk of ICU admission and the mortality rate. Our results are consistent with some previous data demonstrating the beneficial effect of enteral nutrition over total parenteral nutrition [