Conclusions
death, ill, Organ failure, cholangitis
CHOLANGITIS
The results of this post hoc analysis of the MANCTRA-1 study can help overcome current limitations in identifying patients with IPN at the highest risk of death, ultimately leading to early identification of the patients requiring major clinical and interventional efforts. Organ failure (aOR 11.589), acute cholangitis (aOR 3.983), and open surgical necrosectomy (aOR 3.772) 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, as it is a clear determinant of death. Conversely, minimally invasive surgical and endoscopic interventions through a step-up approach should be attempted at the first stage. Patients with IPN should be referred to a specialised centre and taken into a high-dependency or intensive care unit as early as possible.