Abstract
Aims: Acute pancreatitis (AP) is a complex and unpredictable clinical condition with variable outcomes. Early risk assessment is vital for tailored interventions and improved patient outcomes. The computed tomography severity index (CTSI) and modified computed tomography severity index (mCTSI) are radiological scoring systems used to evaluate AP severity.
 Methods: We conducted a single-center retrospective study spanning from January 1, 2018, to December 31, 2022, to compare CTSI and mCTSI in predicting mortality in AP. Data were retrieved from our institution’s electronic records for 266 eligible adult patients. Statistical analysis assessed the relationship between scoring systems, patient demographics, etiology, and mortality.
 Results: Among the 266 patients, 9.4% died. Mortal patients were older (mean age: 72.09±15.12) than survivors (mean age: 59.93±16.93). The most common etiology was biliary pancreatitis (58.64%). mCTSI showed significant differences between the mortality and non-mortality groups (p=0.026), whereas CTSI did not (p=0.112). The ROC analysis for mCTSI yielded an area under the curve of 0.629, with a Youden index of 0.193 (p=0.044). A mCTSI cut-off of 3 had a sensitivity of 59.1% and specificity of 60.2%.
 Conclusion: Advanced age and biliary etiology were associated with increased mortality. mCTSI demonstrated superiority in predicting mortality compared to CTSI.
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