Analysis of factors influencing the complications of severe acute pancreatitis combined with hemorrhage

Abstract Background Complications of hemorrhage in patients with severe acute pancreatitis (SAP) significantly impact prognosis. However, current research on this topic remains limited. This study aims to analyze the factors influencing hemorrhage in SAP patients. Methods This study retrospectively analyzed clinical data from SAP patients admitted to our hospital between January 2019 and December 2022. Using propensity score matching and multivariate logistic regression analysis, we identified independent factors influencing hemorrhage. Additionally, we developed a nomogram prediction model for bleeding in SAP patients and generated an ROC curve to assess its accuracy. Prognosis was also evaluated. Results Based on the exclusion criteria, 804 patients were included in the study, with 97 (12.1%) experiencing hemorrhagic complications. After applying propensity score matching, 440 patients were selected, including 88 with bleeding. Multivariate logistic regression analysis identified several independent factors influencing hemorrhage in SAP: computed tomography severity index (CTSI) score (OR: 1.771, 95% CI: 1.434–2.187, P < 0.001), infected pancreatic necrosis (IPN) (OR: 4.407, 95% CI: 1.854–10.476, P < 0.001), acute physiology and chronic health evaluation II (APACHE II) score ≥ 15 (OR: 12.323, 95% CI: 5.015–30.282, P < 0.001), abdominal compartment syndrome (ACS) (OR: 3.685, 95% CI: 1.462–9.287, P = 0.006), and continuous renal replacement therapy (CRRT) (OR: 0.251, 95% CI: 0.094–0.670, P = 0.006). A nomogram prediction model was constructed, achieving an area under the ROC curve (AUC) of 0.924. The median ICU stay and total hospital stay were significantly longer in the bleeding group compared to the non-bleeding group (30 vs. 7 and 48 vs. 18, P < 0.001). Additionally, the mortality rate was significantly higher in the bleeding group compared to the non-bleeding group (46.6% vs. 6.5%, P < 0.001). Conclusion The occurrence of bleeding complications in SAP signifies a poor prognosis. Therefore, for patients with elevated CTSI and APACHE II scores, especially those with IPN and ACS, it is crucial to enhance monitoring for bleeding. If necessary, CRRT may be implemented to improve the condition and reduce the risk of hemorrhage.