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

  • Akira Endo
  • Atsushi Shiraishi
  • Kiyohide Fushimi
  • Kiyoshi Murata
  • Yasuhiro Otomo
Original Article—Liver, Pancreas, and Biliary Tract

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.

Keywords

Acute pancreatitis Severe acute pancreatitis Protease inhibitor Antibiotics Mortality 

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

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

535_2018_1452_MOESM1_ESM.docx (79 kb)
Supplementary material 1 (DOCX 78 kb)

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Akira Endo
    • 1
  • Atsushi Shiraishi
    • 1
    • 2
  • Kiyohide Fushimi
    • 3
  • Kiyoshi Murata
    • 1
    • 4
  • Yasuhiro Otomo
    • 1
  1. 1.Trauma and Acute Critical Care Medical CenterTokyo Medical and Dental University Hospital of MedicineTokyoJapan
  2. 2.Emergency and Trauma CenterKameda Medical CenterKamogawaJapan
  3. 3.Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
  4. 4.The Shock Trauma and Emergency Medical CenterMatsudo City HospitalMatsudoJapan

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