المؤلفون: Jacquemin, Mathieu, Mokart, Djamel, Faucher, Marion, Ewald, Jacques, Tourret, Maxime, Brun, Clément, Tezier, Marie, Mallet, Damien, Nguyen Duong, Lam, Cambon, Sylvie, Pouliquen, Camille, Ettori, Florence, Sannini, Antoine, Gonzalez, Frédéric, Bisbal, Magali, Chow-Chine, Laurent, Servan, Luca, de Guibert, Jean Manuel, Boher, Jean Marie, Turrini, Olivier, Garnier, Jonathan

المصدر: Shock ; volume 58, issue 5, page 374-383 ; ISSN 1073-2322

الوصف: Background: Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality ( P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis ( P = 0.036), and on day 3, creatinine ( P = 0.025), drain fluid amylase concentration ( P = 0.023), lipase concentration ( P < 0.001), and C-reactive protein (CRP) concentration ( P < 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.

الإتاحة: https://doi.org/10.1097/shk.0000000000001999Test

المؤلفون: Jacquemin, Mathieu

المساهمون: Aix-Marseille Université - École de médecine (AMU SMPM MED), Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM), Aix Marseille Université (AMU)-Aix Marseille Université (AMU), Djamel Mokart

المصدر: Sciences du Vivant [q-bio]. 2021

مصطلحات موضوعية: Hémorragie, Facteurs de risque, Soins intensifs postopératoires, [SDV]Life Sciences [q-bio], Duodénopancréatectomie céphalique, Mortalité, Traitement, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

الوصف: Introduction : l’hémorragie est la moins fréquente mais la plus mortelle des complications post duodénopancréatectomie (DPC). Notre étude s’intéresse à l’incidence, aux caractéristiques, aux facteurs prédictifs, à la mortalité et à la gestion postopératoire de cette complication. Méthode : les données récoltées rétrospectivement concernent 194 patients opérés de DPC entre mai 2007 et mars 2020 dans notre centre de référence régional.Résultats : l’incidence de l’hémorragie post DPC était de 17.5% (34/194) et la mortalité à J90 de 17.6% (6/34). La survenue d’un saignement était indépendamment associée à une surmortalité à J90 (HR 11.45, [1.57-83.59], p=0.02). Les facteurs de risque d’hémorragie postopératoire de l’ensemble des DPC sont le sepsis (HR 7.93, [2.12-29.63], p=0.002) et la fistule pancréatique (HR 8.72, [2.26-33.72], p

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::5bda46f20d04e3789083f46dee6c2581Test
https://dumas.ccsd.cnrs.fr/dumas-03190630Test