Balthazar Computed Tomography Severity Index Research Articles

Nonbiliyer Akut Pankreatit Prognozunda Skorlama Sistemlerinin Tanısal Performansı: Ranson ve Balthazar Skorlarının Karşılaştırmalı Analizi

Amaç: Akut pankreatitli hastalarda ciddiyetin ve prognozunu tahmin edilmesinde Ranson skoru (RS) ve Balthazar Bilgisayarlı Tomografi Şiddet İndeksini (CTSI) yaygın olarak kullanılmaktadır. Ancak, bu skorlama sistemlerinin biliyer olmayan akut pankreatitin prognouzu tahmin etmedeki tanısal üstünlükleri belirsizliğini korumaktadır. Bu nedenle, bu çalışmada nonbiliyer AP'nin prognozunu tahmin etmede RS ve CTSI'yi karşılaştırmayı amaçladık.
 Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2021 ile Mayıs 2023 arasında İç Hastalıkları kliniğinde takip edilen 67 nonbiliyer AP hastası dahil edildi. RS ve CTSI, hastaların laboratuvar ve radyolojik bulgularına dayanarak hesaplanmıştır. Son noktalar, uzun süreli hastanede yatış (≥8 gün), komplikasyonlar ve mortaliteden oluşmaktadır.
 Bulgular: Hastaların ortalama yaşı 50.1±8.3 yıl olup, çoğunluğu erkek (%59.7) idi. Hastaların %11.9'unda komplikasyon gelişti, %26.9'unda uzun süreli hastanede yatış meydana geldi ve %6'sında ölüm gözlendi. Uzun süreli hastanede yatış ve komplikasyon riskini tahmin etmede CTSI, RS'ye göre üstün tanısal performans sergiledi (uzun süreli hastanede kalma için eğri altındaki alan (AUC) = 0.590 vs. 0.856, p

Investigating the correlation between severe acute pancreatitis and pancreatic necrosis with some serum parameters.

Acute pancreatitis (AP) is a disease related to significant morbidity and even mortality. Various factors are involved in the etiology, especially gallstones and excessive alcohol consumption. Although, the course of the disease in most of the cases is generally mild, in some cases, the disease can be severe and lead to pancreatic or peripancreatic necrosis. Radiologically, 'Balthazar computed tomography severity index' (CTSI) is used to assess the severity and presence of necrosis in pancreatitis. In this study, we classified the severity of AP in patients with Balthazar CTSI and investigated whether there is a correlation between some serum parameters and AP severity and which serum parameters can be used as a safe marker to predict the AP severity and the development of pancreatic necrosis (PN). A total of 341 patients diagnosed with AP and hospitalized in our general surgery clinic between the years 2012 and 2018 were included in this study. Hematological and biochemical parameters of the patients were recorded. Abdominal CT's of the patients were evaluated according to the Balthazar CTSI. The correlation between these parameters and AP severity evaluated by Balthazar CTSI was investigated. PN was detected in 19.4% of 341 patients who participated in the study. Patients whose PN detected in their abdominal CT's by Balthazar CTSI; neutrophil counts, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio, plateletlymphocyte ratio, and neutrophil/monocyte ratio (NMR) were significantly higher and the serum albumin was significantly lower than patients with PN. Neutrophil count, serum albumin levels, NLR, LR, and NMR can be used as predictive markers to determine AP severity.

COVID-19 infection initially presented by interstitial edematous pancreatitis and acute peri-pancreatic collection; the first CT case report in Egypt

BackgroundThe extra-pulmonary computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19) have been described in the literature, including the neurologic, cardiac, and abdominal manifestations. Ischemic and inflammatory bowel changes were the most frequent abdominal CT findings. Acute pancreatitis was seldom found all over the world outside of China and described in case reports, but not in Egypt.Case presentationA 44-years-old female patient presented with severe abdominal pain, vomiting, and mild fever for six days. No respiratory symptoms were encountered till the time of the radiological investigation. Abdominal CT examination revealed interstitial edematous pancreatitis with acute peri-pancreatic fluid collection according to the revised Atlanta classification. No pancreatic necrosis or vascular complications were depicted. Secondary pyloro-duodenitis was noticed. The modified Balthazar CT-severity index was moderate (6/10). Basal chest scans showed bilateral variable-sized bronchocentric and sub-pleural consolidative pneumonic patches with mild bilateral pleural effusion. The patient was admitted to the intensive-care unit (ICU) for two weeks. The serum amylase and lipase titers were elevated and the polymerase chain reaction (PCR) test for COVID-19 was positive. She received pancreatic, circulatory, and pulmonary medical support, then she was discharged after stabilization of her condition.ConclusionThe authors provided this case report for the association between COVID-19 infection and acute pancreatitis, which is mostly the first in Egypt. It documented their Egyptian experience to be added to the international literature. It radiologically described their chest and abdominal CT findings in detail using the COVID-19 Reporting and Data System (CO-RADS) and the revised Atlanta classification with modified Balthazar CT-severity index (CTSI). This could eventually enrich the radiological point of view in addition to the previously published clinical case reports.

A Retrospective Analysis between Various Indices of Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is the sudden inflammation of the pancreas and, to a varied degree, involves local tissues or distant organs. The severity of AP can be predicted based on clinical, laboratory, and radiologic risk factors, various severity grading systems, and serum markers. Some of these can be performed on admission to assist in triage of patients. The objective of the study was to determine the relation between various indices of AP. Methods: A retrospective analysis of diagnosed cases of AP of total 200 patients was done. Subjects included both the genders, all age groups including pediatric and geriatric age groups and all classes of socioeconomic strata. Results: There was a significant male preponderance. Most common cause was alcohol abuse in males and gallstone disease in females. There was a good correlation between Balthazar computed tomography severity index and Ranson’s score. Magnitude of enzyme elevation had no relation to the severity of the disease. Irrespective of the cause enzyme elevations was similar quantitatively, but the average lipase value was higher than the average amylase value in all the etiologies. Sensitivity of the ultrasound was good while the specificity was still low. Most common complication was pseudocyst of the pancreas. In the present study, we had the objective of analyzing the various severity indices. Conclusion: The initial management for an AP attack should be conservative; with surgery reserved for cases having uncertainty of diagnosis, trauma, very severe attacks not responding to medical therapy, and complications of the disease. The severity of AP is variable. The ability to predict the severity can help identify patients at increased risk for morbidity and mortality, thereby assisting in appropriate triage and selection of patients for specific interventions.

Assessment of acute pancreatitis using the CT severity index and modified CT severity index

Background: To assess the severity of acute pancreatitis (AP) using computed tomography (CT)severity index (CTSI) and modified CT severity index (MCTSI), to correlate with clinical outcomemeasures, and to assess concordance with severity grading, as per the revised Atlanta classification(RAC). Material and Methods: This is a prospective study, conducted from August 2019 to July2020, in the Department of Radiology, Al Ameen Medical College. A total of 70 patients referred fromthe Department of Medicine and Department of Surgery, presented with the chief complaint ofepigastric pain, nausea and vomiting and CECT abdomen were suggestive of acute pancreatitis wereincluded in this study. Assessment of severity of acute pancreatitis was done in all cases byBalthazar CTSI scoring and Mortele Modified CTSI scoring. Results: In the present study total 70cases of acute pancreatitis cases were included in the study. These patients underwent CT abdomenand pelvis, later images were reviewed by the radiologist. The maximum patients were in the agegroup of 21 to 40 years [n=33 (47.1%)]. Majority of the cases were categorized as mild pancreatitisaccording to Balthazar CTSI score. Majority of the cases were categorized as severe pancreatitisusing the Modified Mortele CTS score. Whereas, organ failure, moderate and severe category inmodified Mortele CTSI, mild, moderate, severe category in Balthazar CTSI. Conclusion: Inconclusion CECT was found to be an excellent imaging modality for diagnosis, establishing theextent of the disease process and in grading its severity.

An observational study to determine relation between various indices of acute pancreatitis

Introduction: Acute pancreatitis is a relatively common disease with wide clinical variation and its incidence is increasing. The severity of acute pancreatitis can be predicted based upon various severity grading systems. Some of these can be performed on admission to assist in triage of patients while others can only be obtained during the first 48 to 72 hours or later. The objective of the study was to determine the relation between various indices of acute pancreatitis. Methods:This observational study involved Prior Consent from the patients & was found to be within ethical standards. A total of 100 patients were selected which were proven cases of Acute Pancreatitis during a period of 2.5 years from year 2016 to 2019. Subjects included both the genders, all age groups including pediatric and geriatric age group and all classes of socio economic strata.Results: Majority of the patients were in the age group of 21-40. There was a clear gender predilection towards males with M:F of 4:1. In all cases, Pancreatic enzymes showed more than threefold higher than the upper limit of normal. 72% of the cases were related to alcoholism. 88% cases were having mild ranson’s score. As per CT Severity index maximum cases were mild in severity.Conclusion: There was a significant male preponderance. Most common cause was alcohol abuse in males and gall stone disease in females. There was a good correlation between Balthazar CT severity index and Ranson‟s score. Magnitude of enzyme elevation had no relation to the severity of the disease. Irrespective of the cause enzyme elevations were similar quantitatively.

Assessment of acute pancreatitis using CT severity index and modified CT severity index: A tertiary care hospital based observational study

Background: This study was conducted to assess the correlation with patient outcome and interobserver variability of a modified CT severity index in the evaluation of patients with acute pancreatitis compared with the currently accepted CT severity index. Material and Methods: This is a prospective study, conducted from January 2019 to December 2019, in the Department of Radio Diagnosis, Noor Hospital, Indian Institute of Medical Science and Research (IIMS&R), Warudi, Badnapur. A total of 63 patients referred from the Department of Medicine and Department of Surgery, IIMS & R presented with the chief complaint of epigastric pain, nausea and vomiting and CECT abdomen were suggestive of acute pancreatitis were included in this study. Assessment of Severity: Assessment of severity of acute pancreatitis was done in all cases by Balthazar CTSI scoring and Mortele Modified CTSI scoring. Results: In our study total 63 cases of acute pancreatitis cases were included in the study. These patients underwent CT abdomen and pelvis, later images were reviewed by radiologist. The maximum patients were in the age group of 21 to 40 years [n=31 (49.2%)]. We found that acute pancreatitis was found three times more common in males than in females. Cholelithiasis was found to be most common aetiological factor for acute pancreatitis in 46% cases followed by alcoholic pancreatitis was seen in 28.5% of cases. Majority of the cases were categorized as mild pancreatitis according Balthazar CTSI score. Majority of the cases were categorized as severe pancreatitis using the Modified Mortele CTS score. Whereas, organ failure, moderate and severe category in modified Mortele CTSI, mild, moderate, severe category in Balthazar CTSI. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection and occurrence of organ failure. It could also predict the need for interventional procedures.

A clinical profile and outcome of patients with acute pancreatitis: A prospective study in North India

Background: Acute Pancreatitis (AP) is an inflammatory process. The average mortality rate in severe AP approaches 2%–10%. Gall stones and alcohol abuse account for 70% of cases of acute pancreatitis. Almost all patients have acute upper abdominal pain. Systemic complications and multi organ system failure may develop. Patients and Methods: A prospective study conducted from November 2016 to December 2017 in Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India, in patients who were diagnosed to have acute pancreatitis. A total of 54 patients were enrolled in the study out of which four patients had left against medical advice. The data collected were evaluated to see the outcome. Results: Majority of patients 22 (44.0%) were in age group ranging from 41 to 60 years. Males were dominant (58%). The most common etiology was alcoholism followed by gall stone. The majority of patients were found with abdominal pain (100.0%). The majority of the patients were having moderate Balthazar CT Severity Index (CTSI) (54.0%). In all, 43 patients were having pancreatic complications and pancreatic necrosis was the commonest; 31 developed extra-pancreatic complications, among which pleural effusion was the commonest. Some patients were having multiple complications. The duration of hospital stay was highest in severe group of Balthazar CTSI. Rise in total leucocyte count, serum amylase level and low calcium levels were significantly associated with increase in pancreatic/extra-pancreatic complications. There was only 1 (2%) patient who died and remaining 49 (98%) patients were discharged. Conclusion: Most common etiology of acute pancreatitis was alcohol consumption (50%) followed by gall stones (32%). Increases in total leucocyte count, serum amylase level and low level of serum calcium were significantly associated with increase in pancreatic/extra-pancreatic complications leading to higher morbidity and hospital stay. Patients with higher Balthazar CTSI were having higher morbidity.

Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone

OBJECTIVE:To present our experience in the management of patients with infected pancreatic necrosis without drainage.METHODS:The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed.RESULTS:We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died.CONCLUSIONS:In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.

Effect of S100A12 and soluble receptor for advanced glycation end products on the occurrence of severe acute pancreatitis.

To assess whether serum levels of S100A12 and soluble receptor for advanced glycation end products (sRAGE) could predict the severity of acute pancreatitis (AP). We conducted a non-interventional pilot study, including 74 AP patients and 28 healthy volunteers serving as controls. AP patients were further divided into the mild (MAP, n = 22), moderately severe (MSAP, n = 30) and severe (SAP, n = 22) groups. Peripheral blood samples were collected within 72 h after the onset of AP for the determination of S100A12, sRAGE and C-reactive protein (CRP) levels. The acute physiology and chronic health evaluation II (APACHE II) score, Balthazar computed tomography severity index (CTSI) were calculated at admission. S100A12 and sRAGE levels in SAP patient were significantly higher than in controls, MAP and MSAP patients. The receiver operating characteristic (ROC) curve analysis demonstrated the predictive ability of S100A12 [sensitivity 91%, specificity 81%, the area under the ROC curve AUROC 0.9047] and sRAGE (sensitivity 57%, specificity 100%, AUROC 0.8304) for evaluating the severity of AP. S100A12 and sRAGE were correlated with APACHE II and CTSI but not with CRP. This combination of new and traditional indicators had higher accuracy than traditional indicators alone. Specifically, S100A12 and sRAGE were positively correlated with the type of organ failure (respiratory and renal failure) and might distinguish transient from persistent organ failure at admission. S100A12 and sRAGE could be used as efficient biomarkers for the early identification of SAP.

Efficacy of pediatric acute pancreatitis scores at a Japanese tertiary center.

Pediatric acute pancreatitis (AP) is a rare but important clinical entity associated with significant morbidity. Predicting the severity and outcome of AP in pediatric patients can be challenging because there are few validated severity scoring systems. Moreover, the etiology of pediatric AP in the Japanese population is different from that of Western populations. The performance of severity scores in pediatric AP with a high prevalence of severe cases is still unknown. The aim of this study was to assess the performance of existing severity scoring systems when used for Japanese children at a tertiary care center. We reviewed the electronic medical records of all children (≤18 years) treated for AP at between 2002 and 2012 at National Center for Child Health and Development, Tokyo. The modified Glasgow acute pancreatitis severity score (modified Glasgow), Ranson criteria (Ranson), Balthazar computed tomography severity index (CTSI), and pediatric acute pancreatitis severity (PAPS) score were assessed for their ability to distinguish severe pancreatitis from the milder forms. Thirty-three Japanese children with AP were identified. Among them, 37 episodes were analyzed for the performance of the scoring systems and 33 for the etiology. The most common etiology of AP was structural abnormality (n = 8). Sensitivity for the modified Glasgow, Ranson, PAPS, and CTSI was 42.9%, 52.4%, 81.0%, and 50.0%, respectively, while specificity was 81.3%, 81.3%, 37.5%, and 76.9%, respectively. We found PAPS to be the most reliable when used for discriminating the severe form of AP from the milder forms at a Japanese tertiary pediatric care center.

Modified Computed Tomography Severity Index for Evaluation of Acute Pancreatitis and its Correlation with Clinical Outcome: A Tertiary Care Hospital Based Observational Study.

Acute Pancreatitis is a very common condition leading to the emergency visits in both developed and developing countries. Computed Tomography plays a pivotal role in the diagnosis and subsequent management of pancreatitis. The modified CT severity index includes a simplified assessment of pancreatic inflammation and necrosis as well as an assessment of extra pancreatic complications. To study role of modified computed tomography severity index in evaluation of acute pancreatitis and its correlation with clinical outcome. This was a hospital based prospective correlative study done on patients of all age groups referred to the Department of Radio diagnosis from the various indoor and outdoor departments of the hospital, with clinical/Laboratory/ultrasonography findings suggestive of acute pancreatitis. The severity of pancreatitis was scored using Modified CT severity index & CT severity index and classified into mild, moderate and severe categories. Total of 50 patients of acute pancreatitis presenting to the emergency department of our hospital were included in the study. Clinical outcome parameters for correlation collected from respective referral departments included, the length of hospital stay (in days), need for surgical intervention, need for percutaneous intervention (aspiration and drainage), evidence of infection in any organ system (combination of a fever > 100°F and elevated WBC >15,000/ mm(3)), evidence of organ failure (PaO2 < 60 mm Hg or need of ventilation, systolic BP of < 90 mm Hg, serum creatinine of >300μmoles/L or urine output of < 500 ml / 24 h) and death. The age of the patients in the study group was in the range of 17 to 80 years. Maximum patients were in the age group 40-50 years (42.0%). The mean age was 42.32 years. Out of 50 cases, 33 (66%) were male and 17 (34%) were females with a male to female ratio of 2:1. Cholelithiasis was found to be most common aetiological factor for acute pancreatitis in 40% cases. Alcoholic pancreatitis was seen in 36% of cases. Together cholelithiasis and alcoholism accounted for 76% of cases. Pleural effusion was the most common extra-pancreatic complication, 28 patients (56%), followed by ascites. Majority of patients were categorized as severe pancreatitis (44%). 38% patients were grouped into moderate pancreatitis and 18% were categorized in mild pancreatitis. The outcome parameters in terms of length of hospital stay, need of intervention, development of infection, and development of organ failure were more in patients with higher modified CT severity index. In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures.

Comparative study of Balthazar Computed Tomography Severity Index and Modified Computed Tomography Severity Index in predicting the outcome of acute pancreatitis

ObjectiveTo compare the Balthazar CT Severity Index and Modified CT Severity Index in predicting the outcome of acute pancreatitis. Materials and methods150 cases of acute pancreatitis, underwent CECT. The scans were reviewed and scored using both CT indices. Severity parameters included length of hospital stay, need for intervention, occurrence of organ failure, evidence of infection, and mortality. Descriptive statistics were used for baseline characteristics. Chi-square or Fisher's exact tests were used to compare the two indices. ResultsUsing Balthazar CTSI with the patient outcome, statistically significant correlation was found between the grades and the length of hospital stay (p = 0.011), development of infection (p = 0.018), occurrence of organ failure (p = 0.027), and mortality (p = 0.019). No correlation, however, was obtained between the score and the need for an interventional procedure (p = 0.126). In contrast, the correlation between the grades under the Modified CT Severity Index and outcome was much stronger (p = 0.000 for length of hospital stay, p = 0.004 for development of infection, p = 0.024 for occurrence of organ failure and p = 0.013 for mortality). It could also accurately predict the need for interventions (p = 0.030). ConclusionThe modified CTSI correlates more closely with patient outcome than the CTSI.

A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

Background/AimsThe bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously.MethodsFifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC).ResultsThe accuracy of BISAP (≥ 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (≥ 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT.ConclusionsBISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

The Effect of Intestinal Permeability and Endotoxemia on the Prognosis of Acute Pancreatitis

Background/AimsEarly intestinal mucosal damage plays an important role in severe acute pancreatitis (AP). Previous studies have shown that intestinal permeability (IP), serum endotoxin and cytokines contribute to the early intestinal barrier dysfunction in AP. This study explored the predictive capacity of IP, endotoxemia and cytokines as prognostic indicators in AP patients.MethodsEighty-seven AP patients were included in the study. The patients were classified into three groups according to the Balthazar computed tomography severity index (CTSI). We compared the biochemical parameters, including IP, serum endotoxin level and cytokine level among the three groups. The associations of IP with serum endotoxin, cytokines, CTSI, and other widely used biochemical parameters and scoring systems were also examined.ResultsIP, serum endotoxin, interleukin (IL-6) and tumor necrosis factor (TNF)-α had a positive correlation with the CTSI of AP. Endotoxin, IL-6, TNF-α, CTSI, the Ranson/APACHE II score, the duration of hospital stay, complications and death significantly affect IP in the AP patients.ConclusionsWe believe that IP with subsidiary measurements of serum endotoxin, IL-6 and TNF-α may be reliable markers for predicting the prognosis of AP. Further studies that can restore and preserve gut barrier function in AP patients are warranted.

Severity Scores in Children With Acute Pancreatitis

Severity scores are used to predict the outcome of acute pancreatitis (AP). Several scores are used in adult patients, but none has been thoroughly validated for specific use in paediatric patients. We retrospectively collected data from 48 children with AP (13 severe and 35 mild). The main causes were trauma (23%), idiopathic (23%), lithiasis (12.5%), and virus (10.5%). We evaluated 3 clinical scores (Ranson, Glasgow modified, and DeBanto) and Balthazar computed tomography severity index. The clinical scores had a good specificity (approximately 85%) but a low sensitivity (approximately 55%) in predicting the severity of paediatric AP. The radiological score is better (sensitivity 80%, specificity 86%). The area under the receiver operator characteristic curve was 0.699 (95% CI 0.508%-0.891%, P = 0.054) for the DeBanto score, 0.846 (95% CI 0.69%-1%, P = 0.001) for the Ranson score, and 0.774 (95% CI 0.584%-0.964%, P = 0.008) for the Glasgow and 0.898 (95% CI 0.73%-1%, P = 0.011) for the Balthazar computed tomography severity index score. In our paediatric cohort, the severity of AP was best predicted by Balthazar computed tomography-based scoring scale. Our results confirm previously reported low sensitivity of adult-based clinical scoring scales.

Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome

To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion (CRAI) via a drug delivery system (DDS) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS). We presented our recent experience in 8 patients with SAP. The patients developed clinical ACS, which required abdominal decompression. During the operation, a DDS was inserted into the peripancreatic artery (the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery). Through this DDS, a protease inhibitor, antibiotics and octreotide were infused continuously. The duration of the regional artery infusion ranged from 8 to 41 d. The outcomes and the changes in the APACHE II score, computed tomography (CT) severity index and intra-abdominal pressure (IAP) of the patients were retrospectively evaluated. Eight patients with an initial APACHE IIscore of 18.9 (range, 13-27) and a Balthazar CT severity index of 9.1 (range, 7-10) developed severe local and systemic complications. These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension (IAH). After a mean interval of 131.9 ± 72.3 d hospitalization, 7 patients recovered with decreased APACHE II scores, CT severity indexes and IAP. The mean APACHE II score was 5.4 (range, 4-8), the CT severity index was 2.3 (range, 1-3), and IAP decreased to 7.7 mmHg (range, 6-11 mmHg) 60 d after operation. One patient died of multiple organ failure 1 wk after surgery. CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.

Comparison of Serum Procalcitonin with Ranson, APACHE-II, Glasgow and Balthazar CT Severity Index Scores in Predicting Severity of Acute Pancreatitis

The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers. Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission. Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021). Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis.

The value of CT in assessing the prognosis of sever acute pancreatitis: a report of 62 cases

To study the relationship between CT imaging classification criteria and the prognosis of severe acute pancreatitis (SAP). From January 2000 to December 2009, 62 cases with SAP were analyzed, retrospectively. They were all executed CT examination in 72 h after admission, and their CT imaging were classified as grade C (n = 13), grade D (n = 26), and grade E (n = 23) according to the Balthazar classification criteria and also classified as grade I (n = 11), grade II (n = 39), grade III (n = 12) according to the Balthazar CT severity index (CTSI) criteria, respectively. The values of these two different classification criteria in assessing the prognosis of SAP were studied, such as length of hospital stay, fever days, fasting days, white blood cell recovery days, serum amylase recovery days, pancreatic pseudocyst, organ failure, need for transit operations, and death. By studying the receiver operating characteristic (ROC) curves, which were drawn by the area under cures, the values of the two different classification criteria were compared in assessing the prognosis of SAP. The Balthazar classification criteria was valuable in assessing white blood cell recovery days (F = 4.035, P = 0.023) and pseudocyst (χ(2) = 8.066, P = 0.018). No statistical differences were found, however, between other clinicopathological parameters and the prognosis of SAP, according to the Balthazar classification criteria. The patients with low-grade of CTSI classification criteria enjoyed better prognosis, and patients in grade I or II got lower incidence of organ failure, need for transit operations and pseudocyst than that in grade III. The results above suggested that CTSI classification criteria, comparing with Balthazar CT classification criteria, was more valuable in predicting the incidence of organ failure, pseudocyst, need for transit operation, and mortality in SAP (P < 0.01). The CTSI classification criteria has a great value in assessing the prognosis of SAP.

Effect of somatostatin on immune inflammatory response in patients with severe acute pancreatitis

Somatostatin regulates immune inflammatory response via apoptosis and adhesion of leukocytes in many diseases. This article reported a study that aimed to observe the mechanism and effect of somatostatin on the immune inflammatory response through apoptosis and adhesion of leukocytes in severe acute pancreatitis. Thirty-eight patients with severe acute pancreatitis, that fulfilled the guidelines for the treatment of severe acute pancreatitis of China and Balthazar computed tomography severity index (>or=5) were enrolled consecutively. Nineteen of these patients received our routine treatment and 19 received additional somatostatin. In all patients the expressions of CD4, CD8, CD95/CD95 ligand and CD18/CD62 ligand on leukocytes were determined by flow cytometry, both upon admission and on the fourth day. Thirty healthy volunteers constituted the normal healthy group. In the treatment group, CD4, CD4:CD8 ratio and CD62 ligand on leukocytes increased from 11.4+/-8.2, 0.47+/-0.10 and 25.5+/-9.2 to 22.1+/-9.7, 0.68+/-0.11 and 36.2+/-11.7 (P<0.05) respectively, while CD95 ligand on both lymphocyte and polymorphonuclear cells increased from 0.65+/-0.21 and 0.76+/-0.29 to 1.18+/-0.32 and 1.58+/-0.43 after treatment with somatostatin (P<0.05). Furthermore, lactate dehydrogenase, aspartate aminotransferase, amylase, C reactive protein and acute physiology and chronic healthy evaluation (APACHE II) score in the treatment group reduced faster than those in the control group (P<0.05), though there was no difference in mortality (15.7% vs 5.3%) between the two patient groups (P>0.05). Somatostatin can modulate the immune inflammatory response and the severity of severe acute pancreatitis through apoptosis and adhesion of leukocytes, but this modulatory effect by itself is not strong enough to improve the final.