Trajectories of prealbumin levels in the early phase of acute pancreatitis are associated with infected pancreatic necrosis

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International Pub Date : 2025-06-07 DOI:10.1016/j.hbpd.2025.06.002

Zi-Rui Liu , Yi-Zhe Chen , Yang Liu , Kang Li , Yi-Zhen Xu , Lin Gao , Lu Ke , Wei-Qin Li

{"title":"Trajectories of prealbumin levels in the early phase of acute pancreatitis are associated with infected pancreatic necrosis","authors":"Zi-Rui Liu , Yi-Zhe Chen , Yang Liu , Kang Li , Yi-Zhen Xu , Lin Gao , Lu Ke , Wei-Qin Li","doi":"10.1016/j.hbpd.2025.06.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Infected pancreatic necrosis (IPN) is a highly morbid local complication following necrotizing pancreatitis. Early enteral nutrition has been proven to be effective in preventing IPN. This study aimed to assess the association between the trajectory of prealbumin (PAB) during the early phase of acute pancreatitis (AP) and the incidence of IPN and other clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective, dual-centered study screened patients with AP admitted to the Center of Acute Pancreatitis, Jinling Hospital and the Affiliated Hospital of Zunyi Medical University from January 2018 to December 2022. The PAB levels during the first week after admission were collected. The primary outcome was the incidence of IPN within 90 days after AP onset. Group-based trajectory modelling was performed to describe the trajectory of PAB levels over time. A Cox proportional hazard model was used to facilitate the interpretation of the time-varying hazard ratio (HR) between PAB and outcomes. Fine-Gray sub-distribution hazard model was adopted for sensitivity analysis.</div></div><div><h3>Results</h3><div>A total of 373 patients were included, of whom 82 (22.0%) were diagnosed with IPN within 90 days. The trajectory model assigned 232 patients to the low-level PAB (L-PAB) group and 141 to the high-level PAB (H-PAB) group. The incidence of 90-day IPN in the L-PAB group was significantly higher than that in the H-PAB group (26.7% vs. 14.2%, <em>P</em> = 0.005). The multivariate Cox regression model showed that a high PAB trajectory was associated with a lower incidence of IPN (HR = 0.52, 95% CI: 0.30-0.89; <em>P</em> = 0.017) after adjustment for potential confounders. In the sensitivity analysis, taking death as a competing risk, high PAB trajectory remained significantly associated with a lower incidence of IPN in the Fine-Gray model (HR = 0.55, 95% CI: 0.33-0.92; <em>P</em> = 0.022).</div></div><div><h3>Conclusions</h3><div>A high PAB trajectory within the first week of AP was significantly associated with a lower incidence of IPN within 90 days after AP onset. Dynamic monitoring of PAB levels in the early phase of AP may play an important role in stratifying patients at high risk of developing IPN.</div></div>","PeriodicalId":55059,"journal":{"name":"Hepatobiliary & Pancreatic Diseases International","volume":"24 4","pages":"Pages 381-387"},"PeriodicalIF":4.4000,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatobiliary & Pancreatic Diseases International","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1499387225000980","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Infected pancreatic necrosis (IPN) is a highly morbid local complication following necrotizing pancreatitis. Early enteral nutrition has been proven to be effective in preventing IPN. This study aimed to assess the association between the trajectory of prealbumin (PAB) during the early phase of acute pancreatitis (AP) and the incidence of IPN and other clinical outcomes.

Methods

This retrospective, dual-centered study screened patients with AP admitted to the Center of Acute Pancreatitis, Jinling Hospital and the Affiliated Hospital of Zunyi Medical University from January 2018 to December 2022. The PAB levels during the first week after admission were collected. The primary outcome was the incidence of IPN within 90 days after AP onset. Group-based trajectory modelling was performed to describe the trajectory of PAB levels over time. A Cox proportional hazard model was used to facilitate the interpretation of the time-varying hazard ratio (HR) between PAB and outcomes. Fine-Gray sub-distribution hazard model was adopted for sensitivity analysis.

Results

A total of 373 patients were included, of whom 82 (22.0%) were diagnosed with IPN within 90 days. The trajectory model assigned 232 patients to the low-level PAB (L-PAB) group and 141 to the high-level PAB (H-PAB) group. The incidence of 90-day IPN in the L-PAB group was significantly higher than that in the H-PAB group (26.7% vs. 14.2%, P = 0.005). The multivariate Cox regression model showed that a high PAB trajectory was associated with a lower incidence of IPN (HR = 0.52, 95% CI: 0.30-0.89; P = 0.017) after adjustment for potential confounders. In the sensitivity analysis, taking death as a competing risk, high PAB trajectory remained significantly associated with a lower incidence of IPN in the Fine-Gray model (HR = 0.55, 95% CI: 0.33-0.92; P = 0.022).

Conclusions

A high PAB trajectory within the first week of AP was significantly associated with a lower incidence of IPN within 90 days after AP onset. Dynamic monitoring of PAB levels in the early phase of AP may play an important role in stratifying patients at high risk of developing IPN.

查看原文本刊更多论文

急性胰腺炎早期白蛋白水平的变化轨迹与感染性胰腺坏死有关。

背景：感染性胰腺坏死（IPN）是坏死性胰腺炎后高度病态的局部并发症。早期肠内营养已被证明对预防IPN有效。本研究旨在评估急性胰腺炎（AP）早期前期白蛋白（PAB）轨迹与IPN发生率和其他临床结局之间的关系。方法：本回顾性双中心研究筛选2018年1月至2022年12月在金陵医院和遵义医科大学附属医院急性胰腺炎中心住院的AP患者。收集入院后第一周的PAB水平。主要终点是AP发病后90天内IPN的发生率。采用基于组的轨迹建模来描述PAB水平随时间的变化轨迹。采用Cox比例风险模型来解释PAB与预后之间的时变风险比（HR）。采用细灰色亚分布风险模型进行敏感性分析。结果：共纳入373例患者，其中82例（22.0%）在90天内诊断为IPN。轨迹模型将232例患者分配到低水平PAB （L-PAB）组，141例患者分配到高水平PAB （H-PAB）组。L-PAB组90天IPN发生率显著高于H-PAB组（26.7% vs. 14.2%, P = 0.005）。多因素Cox回归模型显示，高PAB轨迹与较低IPN发生率相关(HR = 0.52, 95% CI: 0.30-0.89；P = 0.017)，校正了潜在混杂因素。在敏感性分析中，将死亡作为竞争风险，在Fine-Gray模型中，高PAB轨迹仍然与较低的IPN发生率显著相关(HR = 0.55, 95% CI: 0.33-0.92；P = 0.022)。结论：AP第一周内较高的PAB轨迹与AP发病后90天内较低的IPN发生率显著相关。在AP早期动态监测PAB水平可能对IPN高危患者的分层起重要作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Hepatobiliary & Pancreatic Diseases International 医学-胃肠肝病学

CiteScore

5.40

自引率

6.10%

发文量

152

审稿时长

3.0 months

期刊介绍： Hepatobiliary & Pancreatic Diseases International (HBPD INT) (ISSN 1499-3872 / CN 33-1391/R) a bimonthly journal published by First Affiliated Hospital, Zhejiang University School of Medicine, China. It publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases. Papers cover the medical, surgical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas under the headings Liver, Biliary, Pancreas, Transplantation, Research, Special Reports, Editorials, Review Articles, Brief Communications, Clinical Summary, Clinical Images and Case Reports. It also deals with the basic sciences and experimental work. The journal is abstracted and indexed in SCI-E, IM/MEDLINE, EMBASE/EM, CA, Scopus, ScienceDirect, etc.