早期直接接受三级医院专科治疗可降低严重急性胰腺炎的风险：一项倾向评分匹配的回顾性队列研究

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2026-05-01 Epub Date: 2026-02-05 DOI:10.1016/j.pan.2026.02.002

Yuping Ren , Liang Xia , Lingyu Luo , Huifang Xiong , Zhijian Liu , Xin Huang , Yupeng Lei , Yin Zhu , Nonghua Lu , Jianhua Wan , Wenhua He

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引用次数: 0

摘要

背景：急性胰腺炎（AP）患者转至三级医院前延迟专科治疗（DST）对疾病进展的影响尚不清楚。本研究使用倾向评分匹配（PSM）调查DST与严重急性胰腺炎（SAP）风险之间的关系。方法：选取南昌大学第一附属医院2014-2023年收治的5818例AP患者，将患者分为DST组和非DST组。一个1:1的PSM， 0.2 SD卡尺宽度平衡16个基线协变量。多变量逻辑回归评估DST对SAP的影响，支持反概率加权和亚组分析。结果：PSM（2215对）后，DST组SAP发生率较高（19.5% vs. 14.9%; aOR = 1.38, 95%CI 1.18-1.62），胰腺坏死（18.1% vs. 15.4%），持续性呼吸衰竭（16.3% vs. 12.4%），中位住院时间较长（8 vs. 7天，均p < 0.05）。亚组分析显示BMI≥24 （OR = 1.44）和酒精使用者（OR = 1.62）的风险放大。敏感性分析证实了稳健性（加权OR为1.14-1.52），而死亡率无组间差异。结论：DST独立增加SAP风险。早期直接接受三级专科治疗可降低38%的SAP风险，这为优化AP管理途径，特别是优先考虑肥胖和酗酒人群的快速转诊提供了高水平的证据。

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Early direct admission to tertiary hospital specialized care reduces risk of severe acute pancreatitis: A propensity score-matched retrospective cohort study

Background

The impact of delay in specialized treatment (DST) on disease progression in acute pancreatitis (AP) patients before transfer to tertiary hospitals remains unclear. This study investigates the association between DST and risk of severe acute pancreatitis (SAP) using propensity score matching (PSM).

Methods

Based on 5818 AP patients treated at The First Affiliated Hospital of Nanchang University (2014–2023), patients were divided into DST and non-DST groups. A 1:1 PSM with 0.2 SD caliper width balanced 16 baseline covariates. Multivariable logistic regression evaluated DST's effect on SAP, supported by inverse probability weighting and subgroup analyses.

Results

After PSM (2215 pairs), the DST group exhibited higher SAP incidence (19.5% vs. 14.9%; aOR = 1.38, 95%CI 1.18–1.62), pancreatic necrosis (18.1% vs. 15.4%), persistent respiratory failure (16.3% vs. 12.4%), and longer median hospitalization (8 vs. 7 days; all p < 0.05). Subgroup analyses revealed amplified risks in BMI≥24 (OR = 1.44) and alcohol users (OR = 1.62). Sensitivity analyses confirmed robustness (weighted OR 1.14–1.52), while mortality showed no intergroup difference.

Conclusions

DST independently increases SAP risk. Early direct admission to tertiary specialized care reduces SAP risk by 38%, providing high-level evidence for optimizing AP management pathways, particularly prioritizing rapid referral for obese and alcohol-using populations.

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.