Incidence of infections in patients with severe acute pancreatitis and associated factors ; Incidence des infections chez les patients admis en réanimation pour pancréatite aiguë sévère et facteurs associés

Background: severe acute pancreatitis (SAP) is a frequent pathology with a rate of mortality that can reach up to 35% due to major systemic inflammatory reaction. However, it remains difficult to early identify a septic process within the inflammatory storm linked to this pathology. Thus, the use of anti-infective therapies is currently controversial. The aim of this study is to investigate the incidence of infections in patients with SAP and identify the factors associated with it.Material and method: this is a retrospective observational descriptive study carried out in the intensive care unit (ICU) of the University Hospital of Nice, regional reference center for SAP. Adults patients whom presented severe AP between October 2013 and November 2021 were included and compared according to the presence of a proven infection. The primary outcome was to determine the incidence of infections. The second outcome was to identify the clinical and biological characteristics related to the infection. For all the descriptive analyses, differences were considered significant when p-value was < 0.05.Results: among the 195 patients included, 67% declared an infection, mainly pulmonary and bacteremia. Infected patients showed more hemodynamic failure, acute kidney injury KDIGO III, and acute respiratory distress syndrome and higher values of procalcitonin (PCT). In multivariate analysis hemodynamic failure and paralytic ileus on CT scan are independently associated with the sepsis (OR 2.7, IC 1.1-6.7; p=0.03 and OR 3.0, IC 1.3-7.1; p=0.01). More discreetly it seems that the peak of procalcitonin (PCT) is also higher in septic patients (OR 1.1, IC 1.0-1.2, p=0.03).Conclusion: in patients with severe AP, this study identified two clinically relevant elements associated with sepsis for which probabilistic anti-infective therapy is justified: hemodynamic failure and the presence of a paralytic ileus. ; La pancréatite aiguë sévère est une pathologie fréquente avec un taux de mortalité qui peut atteindre jusqu'à 35 % en raison ...