IDDF2019-ABS-0112\u2005Predictors of outcome of percutaneous catheter drainage of acute pancreatitis with fluid collection and development of a predictive model

Abstract

Background Percutaneous catheter drainage (PCD) is an effective initial strategy of step-up approach for the management of acute pancreatitis (AP). The objective of this study was to identify factors associated with outcomes after PCD Methods This prospective observational study was conducted from July 2016 - Nov 2017. A total of 101 consecutive AP patients were recruited. Step up approach was followed for the management of patients. We evaluated the association between success of PCD ( survival without necrosectomy) and baseline parameters (aetiology, demography, severity scores(SIRS,APACHE II, organ failure),total leucocyte count, C-reactive protein(CRP), and intra-abdominal pressure (IAP), morphologic characteristics on computed tomography, percentage of necrosis , CT severity index (CTSI), characteristics of collection before PCD (timing, nature of collection, volume, site, solid component), PCD parameters (initial size, maximum size, number and duration of drainage) and factors after PCD insertion ( fall in IAP, reduction in volume of collection). Results Among 101 patients of AP, 51patients required PCD. The success of PCD 66.66% (34/51). Four patients required surgical necrosectomy after PCD. Mortality was 29.4% (15/51, including 2 deaths after necrosectomy). Multivariate analysis(6 factors included after univariate analysis) showed the percentage of volume reduction of fluid collection (p=0.016) and organ failure (OF) resolution(p=0.023) after one week of PCD predicted success of PCD. A predictive model based two factors resulted in AUROC- 0.915. Internal validation by bootstrapping of 5000 resamples showed AUROC 0.906 & is similar to the original model. Nomogram was developed with above factors to predict the probability of success of PCD((figure 1. Nomogram for predictor of PCD success in managing fluid collection in patients with necrotizing pancreatitis total points line indicates total points obtained from predictors and which is synchronized w) figure 1: Total points line indicates total points obtained from predictors and which is synchronized with probability of PCD success line which indicates probability of PCD success). (table 1).Abstract IDDF2019-ABS-0112 Table 1 Final logistic regression model Beta co-efficient P value OR 95 % CI of OR Intercept −4.83 0.003 0.008 Organ failure resolution after PCD (Yes) 3.339 0.001 28.20 3.90–203.87 Percentage of volume reduction of collection after PCD 0.053 0.005 1.055 1.06–1.095 Conclusions Organ failure resolution and reduction in volume of collection after one week of PCD are significant predictors of successful PCD in patients with pancreatic fluid collection.