Computerized Tomography Score for the Assessment of Multiple Organ Failure and Determining Severity of Pancreatitis: Key Principles for the Assessment of Affected Organs

Abstract

BACKGROUND: Pancreatitis severity is an important death rate indicator that plays a crucial role in deciding on proper handling of patients at their initial admission, when making a decision on patient’s transfer to the intensive care unit. Many studies point out a direct relation between death rate and the number of affected organs. In view of that, looking for new criteria for assessment of multiple organ failure is still useful in clinical practice. Assessment of multiple organ failure with patients undergoing treatment in the intensive care unit is carried out with the use of various integrated indicators based both on clinical laboratory assessment of patient’s condition, and on data obtained with the help of advanced imaging methods. However, many researchers point out that the facilities of diagnostic radiology, including in particular computerized tomography (CT), are not used to the full extent.
 AIM: We proposed expanding functionality of abdominal CT examination by means of pancreatitis severity assessment that takes into account changes in the pancreas and in addition enables assessing multiple organ failure with examined patients. We identified the organs and systems whose changes need to be monitored through CT imaging to be able to assess multiple organ failure in the patients with pancreatitis.
 METHODS: Out of 314 patients, 100 patients were selected diagnosed with pancreatitis confirmed by changes demonstrated by the laboratory test results. Of those, 24 patients (24.0%) revealed presence of multiple organ failure (maximum of 5 organ systems), 46 patients revealed a single organ failure.
 RESULTS: Development of early organ failure accompanied 82% of cases of severe pancreatitis and considerably aggravated predicted outcome and course of severe AP. Among them, 30 patients had pancreatitis without changes of the vital organs and 70 patients had dysfunctions of the vital organs, suffered from organ or multiple organ failure, and received treatment in the surgery unit and the intensive care unit of the Department of Surgical Conditions of Karaganda Medical University. In view of CT results, we assessed a relation between multiple organ failure and specific failure of a single organ and necrosis and death rate. We analyzed a relation between organ failure and degree of the pancreas necrosis.
 CONCLUSION: Identified changes enabled us to create a CT score for the assessment of pancreatitis severity that can be used not only for identification but also for the prediction of organ failure at an early stage of pancreatitis with high accuracy as compared against conventional CT systems for the assessment of patients’ condition. It can also be used to differentiate extent organ dysfunction and the number of affected organs.