[Surgical rescue for severe acute pancreatitis complicated by infected pancreatic necrosis and sepsis: a clinical practice analysis].

Abstract

Objective: To investigate the therapeutic efficacy of surgical rescue (SR) in patients with severe acute pancreatitis (SAP) complicated by infected pancreatic necrosis (IPN) and sepsis,and to identify the risk factors associated with SR failure. Methods: Clinical data were retrospectively collected from 130 patients with SAP complicated by IPN who developed sepsis and were admitted to the First Affiliated Hospital of Harbin Medical University between January 2019 and October 2025. The cohort included 86 males and 44 females,with an age(M(IQR)) of 47(21) years (range:22 to 74 years). Patients were divided into an SR group (n=86) and a non-SR group (n=44) based on whether SR was performed. Significant differences were observed between the two groups in age,Balthazar-CTSI score,and creatinine and urea nitrogen levels at the onset of sepsis (all P<0.05). After propensity score matching (PSM) with a 1∶1 nearest-neighbor method and a caliper value of 0.2 to balance baseline characteristics,76 patients were included (38 in each group). Patients were also divided into an SR success group (n=52) and an SR failure group (n=34). Univariate analysis was performed using independent sample t-test,Mann-Whitney U test,chi-square test,or Fisher's exact test as appropriate. Variables with P<0.05 in univariate analysis were included in a multivariate logistic regression model. The predictive value of the model for SR failure was assessed using receiver operating characteristic (ROC) curve analysis. Results: Multivariate logistic regression analysis identified SR as an independent protective factor for survival (OR=0.184,95%CI: 0.063 to 0.537,P<0.05). Kaplan-Meier survival curves showed that the 28-d cumulative survival rate was higher in the SR group than that in the non-SR group (χ²=14.950,P<0.05). Multivariate Logistic analysis identified age (OR=1.188, 95%CI: 1.068 to 1.322),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score (OR=1.303,95%CI: 1.043 to 1.628),sequential organ failure assessment (SOFA) score at the onset of sepsis (OR=1.840,95%CI: 1.205 to 2.811), and timing of first SR (OR=3.004, 95%CI: 1.208 to 7.469) as independent risk factors for SR failure (all P<0.05). The area under the ROC curve was 0.950 (95%CI: 0.903 to 0.997). Conclusions: SR can prolong survival time in SAP patients with IPN who develop sepsis. Age, higher APACHE Ⅱ score,higher SOFA score at initial sepsis diagnosis,and delayed time to first SR are independent prognostic factors for SR failure.