Evaluation of the modified CT severity index (MCTSI) and CT severity index (CTSI) in assessing severity and clinical outcomes in acute pancreatitis

Abstract

Background: The aim of our study was to compare the MCTSI, CTSI and APACHE II indices for predicting local complications and severity in acute pancreatitis (AP). Methods: Clinical data of 137 patients enrolled prospectively at our institution were analyzed. They underwent contrast-enhanced CT within the first week of symptom onset. Parameters evaluated were: local complications (pancreatic necrosis infection, need for invasive procedures against necrosis) and AP severity (persistent organ failure, admission to intensive care unit (ICU), PA severity according to the Atlanta Classification) and mortality. Chi-square and area-under-the-curve receiver-operating characteristics (AUC) were applied. Results: For local complications, the CTSI index showed little superiority over the MCTSI and APACHE II index in predicting an invasive procedure (AUC 0.824, CI: 0.71–0.94) and pancreatic necrosis infection (AUC 0.823, CI: 0.70–0.95). For AP severity prediction, the MCTSI showed superiority over CTSI and APACHE II for every single criteria evaluated: persistent organ failure (AUC 0.747, CI: 0.64–0.85) AP severity (AUC 0.758, CI: 0.65–0.87), need for ICU (AUC 0.736, CI: 0.61–0.86) and mortality (AUC 0.826, CI: 0.72–0.94). Conclusion: The MCTSI index more accurately predicts acute pancreatitis severity than CTSI and APACHE II. MTCSI is also a good local complications predictor such as need of intervention and pancreatic necrosis infection.