Extrapancreatic Inflammation on Abdominal Computed Tomography as an Early Predictor of Disease Severity in Acute Pancreatitis

Abstract

To introduce a new scoring system based on signs of systemic inflammation on computed tomography (CT) [ExtraPancreatic Inflammation on CT (EPIC) score] and evaluate this score as an early prognostic tool. Forty patients with acute pancreatitis who received an abdominal CT within 24 h after admission were included in the study. The Balthazar score, the CT Severity Index, and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal fluid collections) were calculated for all patients. The end points were the occurrence of severe acute pancreatitis (local complication or presence of organ failure for more than 48 h) and in hospital mortality. This score was evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Mean age of the patients was 50 (+/-17.7) years, and Ranson score was 3.3. Fourteen (35%) patients developed severe disease; in hospital mortality was 15% (6/40). The mean EPIC score was 3.6 (+/-2.0). The area under the ROC curve for predicting severe disease and mortality was 0.91 (95% confidence interval, 0.83-0.99) and 0.85 (95% confidence interval, 0.71-0.99), respectively. An EPIC score of 4 or more had a 100% sensitivity and 70.8% specificity for predicting severe pancreatitis. The EPIC score was superior to the Balthazar score and CT Severity Index to predict outcome. In patients with acute pancreatitis, extrapancreatic inflammation assessed by abdominal CT scan and quantified with the EPIC score allows accurate estimation of disease severity and mortality within 24 h of admission.