The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95percent-flag-change CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95percent-flag-change CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95percent-flag-change CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95percent-flag-change CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95percent-flag-change CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95percent-flag-change CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95percent-flag-change CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p ylt; 0.001; 95percent-flag-change CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95percent-flag-change CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95percent-flag-change CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.].
