Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: 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; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% 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 < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% 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)

Democracy’s Plight in the European Neighbourhood: Struggling transitions and proliferating dynasties. CEPS Paperbacks. October 2009

Is international democracy promotion in the European neighbourhood running out of steam, after the disappointing results from the ‘colour revolutions’ in Georgia and Ukraine of 2004-2005? What is the changing impact of factors such as corrupt state capture, energy resources, rent-seeking behaviour, the financial crisis and the perceived threat of radical Islam on democratisation in the region? Research into these questions, among others, and what certain analysts describe as a ‘democracy backlash’ was conducted in three groups of states: countries in or near the EU; former Soviet Union states and three Arab states of the Southern Mediterranean. The results show a parting of the ways between on the one hand the EU’s European neighbours (other than Russia), which are seen to be ‘struggling transitions’ aiming at the European model of democracy, but with serious failings still to be overcome; and on the other hand Russia and the states of Central Asia and North Africa where there is no tendency towards democracy but rather a contrary trend of ‘proliferating dynasties’. This new paperback: Democracy’s Plight is the result of that research, edited by Michael Emerson of CEPS and Richard Youngs of FRIDE, Madrid