Abstract：
OBJECTIVE: In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate recent evidence from published studies to determine the relative importance of IPN and OF as determinants of mortality in patients with AP (PROSPERO: CRD42020176989).
METHODS: Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance.
RESULTS: Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032).
CONCLUSIONS: Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.
METHODS: Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance.
RESULTS: Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032).
CONCLUSIONS: Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.
摘要：
目的：在急性胰腺炎（AP）患者中，在过去的十年中，微创治疗和逐步方法已被广泛用于处理感染性胰腺坏死（IPN）。目前尚不清楚IPN是否已成为相对于器官衰竭（OF）的死亡率较不重要的决定因素。我们旨在统计汇总已发表研究的最新证据，以确定IPN和OF作为AP患者死亡率决定因素的相对重要性（PROSPERO：CRD42020176989）。
方法：相关研究来源于MEDLINE和EMBASE数据库。分析相对风险（RR）或加权平均差（WMD）作为结果。小于0.05的双侧P值被视为有统计学意义。
结果：纳入43项研究，包括11601例AP患者。OF患者的死亡率为28%，IPN患者的死亡率为24%。与没有IPN的患者相比，没有IPN的OF患者的死亡风险明显更高（RR3.72，P<0.0001）。然而,OF和IPN患者面临的死亡风险最高.此外,IPN增加了OF患者的住院时间（WMD28.75，P=0.032）。
结论：尽管IPN仍然是一个重要的问题，导致发病率增加和住院时间延长，与AP中的OF相比，它是一个不太关键的死亡率决定因素。
方法：相关研究来源于MEDLINE和EMBASE数据库。分析相对风险（RR）或加权平均差（WMD）作为结果。小于0.05的双侧P值被视为有统计学意义。
结果：纳入43项研究，包括11601例AP患者。OF患者的死亡率为28%，IPN患者的死亡率为24%。与没有IPN的患者相比，没有IPN的OF患者的死亡风险明显更高（RR3.72，P<0.0001）。然而,OF和IPN患者面临的死亡风险最高.此外,IPN增加了OF患者的住院时间（WMD28.75，P=0.032）。
结论：尽管IPN仍然是一个重要的问题，导致发病率增加和住院时间延长，与AP中的OF相比，它是一个不太关键的死亡率决定因素。
