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Impact of continuous regional arterial infusion in the treatment of acute necrotizing pancreatitis: analysis of a national administrative database

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Although continuous regional arterial infusion (CRAI) of protease inhibitors and broad antibiotics has been suggested as one of the therapeutic option for patients with acute necrotic pancreatitis (ANP), the effectiveness has not been well-corroborated in clinical studies.

Methods

We conducted a retrospective cohort study using a Japanese national administrative database. Severe acute pancreatitis patients with a poorly enhanced pancreas region (i.e., definitive or clinically suspected ANP) were identified and dichotomized according to whether CRAI was performed. We compared the outcomes of in-hospital mortality, surgical interventions, hospital-free days, and healthcare costs between groups adjusted by the well-validated case-mix adjustment model using a multivariate mixed-effect regression analysis and a propensity score matching analysis.

Results

Of 243,312 acute pancreatitis patients, 702 eligible patients were identified, of these 339 patients underwent CRAI. The case-mix adjustment model established had good predictability for in-hospital mortality with an area under the receiver operating characteristics curve of 0.87. CRAI was significantly associated with reduced in-hospital mortality [14.5% in the CRAI group vs. 18.2% in the non-CRAI group, adjusted odds ratio (95% confidence interval; CI) = 0.60 (0.36–0.97)]. Significant associations were not observed for the frequency of surgical interventions and mean hospital-free days; however, significantly higher healthcare costs were observed in the CRAI group. Results of the propensity score matching analysis did not alter these results.

Conclusions

Analysis of a nationwide large-scale database suggested that CRAI was significantly associated with reduced in-hospital mortality for patients with ANP. Further randomized controlled trials are warranted.

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Abbreviations

ANP:

Acute necrotizing pancreatitis

AUROC:

Area under the receiver operating curve

CI:

Confidence interval

CRAI:

Continuous regional arterial infusion

CT:

Computed tomography

DPC:

Diagnosis procedure combination

ICD-10:

International Classification of Diseases, 10th revision

ICU:

Intensive care unit

RCT:

Randomized controlled trial

SAP:

Severe acute pancreatitis

SD:

Standard deviation

VIF:

Variance inflation factor

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Acknowledgements

AE received the Grants-in-Aid for Scientific Research (#17K17045) from Japan Society for the Promotion of Science. KF received a Grant-in-Aid for Research on Policy Planning and Evaluation (#H28-Seisaku-Shitei-009) from the Ministry of Health, Labour and Welfare, Japan. Remaining authors received no funding. The authors thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Akira Endo, Atsushi Shiraishi, Kiyoshi Murata & Yasuhiro Otomo

  2. Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan

    Atsushi Shiraishi

  3. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Kiyohide Fushimi

  4. The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, 4005, Kamihongo, Matsudo, Chiba, Japan

    Kiyoshi Murata

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  1. Akira Endo
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  2. Atsushi Shiraishi
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Correspondence to Akira Endo.

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Endo, A., Shiraishi, A., Fushimi, K. et al. Impact of continuous regional arterial infusion in the treatment of acute necrotizing pancreatitis: analysis of a national administrative database. J Gastroenterol 53, 1098–1106 (2018). https://doi.org/10.1007/s00535-018-1452-4

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  • DOI: https://doi.org/10.1007/s00535-018-1452-4

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