CT Severity Index Research Articles

Observation on the therapeutic effect of probiotics on early oral feeding in the treatment of severe acute pancreatitis

ObjectivesTo evaluate the clinical efficacy of probiotics and early oral feeding in patients with severe acute pancreatitis.MethodsA prospective, randomized, controlled trial was conducted involving 66 patients, who were randomly divided into a control group (n = 32) receiving standard enteral nutrition and an observation group (n = 34) receiving additional Bifidobacterium quadruplex live bacterial tablets. Serum inflammatory markers, including white blood cells (WBC), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP), were measured on days 1, 3, and 7 post-admission. Abdominal pain scores, the computed tomography severity index (CTSI), and the Bedside Index for Severity in Acute Pancreatitis (BISAP) scores were also assessed. Additionally, defecation time and the total duration of hospitalization were compared between the two groups.ResultsInflammatory markers declined in all groups by the third day post-admission, with the observation group exhibiting a significantly greater reduction compared to the control group (p < 0.05). Similarly, from the first day to the third day, both groups experienced a decrease in abdominal pain scores, CTSI, and BISAP scores, with the observation group showing a significantly more pronounced decrease in BISAP scores compared to the control group (p < 0.05). By the seventh day of admission, inflammatory markers continued to decline in all groups compared to the third day, except for TNF-α levels, and the observation group demonstrated a significantly greater decrease compared to the control group (p < 0.05). Abdominal pain scores, CTSI, and BISAP scores also decreased further in both groups compared to the third day, with the observation group again showing a significantly greater improvement than the control group (p < 0.05). Additionally, the observation group had a significantly shorter time to bowel movement resumption (38.23 ± 2.31 h vs. 43.43 ± 2.75 h, p = 0.013) and total hospital stay compared to the control group (10.97 ± 0.35 days vs. 13.40 ± 0.50 days, p < 0.001).ConclusionEarly oral ingestion combined with probiotics can reduce the levels of inflammatory factors, improve abdominal pain symptoms, alleviate pancreatic edema and shorten defecation time and hospital stay in patients with severe acute pancreatitis.

Assessing the Efficacy of Modified CT Severity Index Versus Conventional CT Severity Index in Determining Severity and Clinical Outcomes of Chronic Obstructive Pulmonary Disease (COPD)

Assessing the Efficacy of Modified CT Severity Index Versus Conventional CT Severity Index in Determining Severity and Clinical Outcomes of Chronic Obstructive Pulmonary Disease (COPD)

Psoas Muscle Index and Density as Prognostic Predictors in Patients Hospitalized with Acute Pancreatitis.

Background: Early prognostication of acute pancreatitis (AP) patients for those at high risk of complications during hospitalization can facilitate clinical decision-making. Sarcopenia has been proven to be a risk factor for poor prognosis in patients with AP. We aimed to evaluate the association between the muscle parameters measured in computed tomography (CT) and the clinical outcomes of hospitalized patients with AP. Methods: A total of 132 consecutive patients hospitalized between 1 January 2015 and 31 December 2021 for AP with a valid CT scan were analyzed. The first CT conducted during hospitalization was analyzed for psoas muscle area (PMA), index (PMI), and density (PMD) at the L3 vertebral level. The main adverse outcomes indicating a worse prognosis were the development of extrapancreatic complications, infections, ICU transfer, in-hospital mortality, and hospitalization length. Results: The lowest tertile of PMI, as a surrogate for sarcopenia, was significantly correlated with increased rates of extrapancreatic complications, infections, and longer hospitalizations. It was additionally correlated with a worse CT severity index. The results for PMA and PMD also showed worse outcomes, largely mirroring the results for PMI. Although in-hospital mortality was relatively low, none of the patients died in the highest tertile of PMI. A clear cutoff with sufficient predictive capability could not be found. Conclusions: A low psoas muscle index can serve as an additional potential predictive marker for more severe disease and worse outcomes in hospitalized acute pancreatitis patients. More studies are needed to determine its combination with existing prediction tools.

Correlation of Biochemical Markers with Chest CT Severity Index and Oxygen Saturation in Moderate to Severe COVID-19 Patients: A cross-sectional study

Introduction: COVID-19, a global pandemic, has been linked to biochemical parameters such as Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Total Leucocyte Count (TLC), Neutrophil/Lymphocyte Ratio (NLR), Lactate Dehydrogenase (LDH), and liver function tests, which correlate with disease severity. Prothrombotic markers like D-Dimer and Fibrinogen levels, along with the CT Severity Index (CTSI) indicating lung involvement, are associated with clinical worsening. This study aims to observe biochemical and chest radiological profiles in moderate to severe COVID-19 patients and explore any correlations between them. Methodology: A hospital-based cross-sectional observational study was conducted at a Medical College and Hospital in Kolkata, involving 80 symptomatic COVID-19 patients with SpO₂ ≤94%. Patients with liver, kidney, chronic inflammatory diseases, COPD, malignancy, or asthma were excluded. Results: Out of 80 patients, 29 had moderate and 51 had severe illness. Statistically significant differences were observed in TLC, ESR, CRP, AST, ALT, A:G ratio, LDH, Fibrinogen, and D-Dimer between moderate and severe cases. The CTSI correlated significantly with TLC, NLR, CRP, AST, ALT, A:G ratio, LDH, Fibrinogen, and D-Dimer. CTSI values also differed significantly between moderate and severe COVID-19 cases. Conclusion: Biochemical markers such as ESR, TLC, CRP, liver enzymes, LDH, D-Dimer, and Fibrinogen can help predict disease severity. These markers also correlate with radiological severity in COVID-19.

Natural History and Microbiological Profiles of Patients With Acute Pancreatitis With Suspected Infected Pancreatic Necrosis.

Acute pancreatitis (AP) is a prevalent emergency. The clinical spectrum of the condition is varied, ranging from a mild to a malignant course with higher mortality rates. Infection of pancreatic/peri necrosis, extrapancreatic infections, and organ failure are significant complications in AP. In the recent era, microbiological composition has shifted more towards multi-drug-resistant organisms due to irrational antibiotic use. This study aims to understand the natural history of patients with suspected infected pancreatic necrosis (IPN), the prevalence of multi-drug-resistant organisms (MDROs), and their antibiotic susceptibility patterns. This prospective, observational study was performed on 130 cases of acute necrotizing pancreatitis (ANP) with suspected IPN that were evaluated during their period of admission in the department of gastroenterology, emergency medicine, or surgery ward of thePostgraduate Institute of Medical Education and Research, Chandigarh, India, a tertiary hospital. The details of outcomes were recorded. The organisms in cases with IPN and antibiotic resistance patterns of various organisms were studied. The most prevalent site of necrosis was combined pancreatic and peripancreatic tissues in 111 (85.4%) patients. The computed tomography severity index (CTSI) had a mean of 8.72±1.43. Of all participants, 36 (27.7%) patients had <30% necrosis, 47 (36.2%) had 30%-50% necrosis, and 47 (36.2%) had >50% necrosis. Overall, 80 (61.5%) patients had organ failure, with acute lung injury (ALI) being the most common. Rates of complications were markedly greater in cases with higher pancreatic necrosis and with infected necrosis (p<0.05). The most common organism isolated from necrotic tissue was Escherichia coli (E. coli) in 17 (32.07%) cases, followed by Acinetobacter baumannii (A. baumannii) in 12 (22.64%) cases. The most common extrapancreatic infection site was respiratory tract infections. Pseudomonas aeruginosa (P. aeruginosa) and A. baumannii revealed maximum resistance to most of the drugs. Conclusion: Infected pancreatic necrosis is linked to high rates of morbidity and mortality. Our study suggests that irrational usage of antibiotics increases the incidence of combined infection, especially with higher rates of multi-drug-resistant infections.

Does the site, size, and number of necrotic collections affect the outcome of necrotizing pancreatitis? - a prospective analysis.

In patients with acute necrotizing pancreatitis (ANP), the site, size, and the number of acute necrotic collections (ANC) may determine the outcome of patients. The current study aimed to correlate the nature of ANC with the adverse outcomes in ANP patients. This was a single-center, prospective study (August 2019-August 2022) recruiting patients with ANP, correlating the site, size, and number of ANC with the length of hospital stay, intensive care unit (ICU) stays, development of organ failure and infection, need for intervention, and mortality. A total of 114 patients (mean age: 37.3 ± 13.4 years, 85.1% males) with ANP were included in the study. The number and maximum diameter of collections significantly correlated with the length of the hospital and ICU stay and the need for intervention. Taking a cut-off size of 8cm, the sensitivity and specificity for predicting the need for intervention were 82.7% and 74.2%, respectively. ANCs located in the perinephric, paracolic, subhepatic, and epigastric regions had a significant correlation with two or more adverse outcomes. Additional points were added to the modified CT severity index (mCTSI) based on the present study's findings. The new score had significantly higher AUROC than mCTSI for predicting infection, need for intervention, ICU stay > 1 week, and mortality. The site, size, and number of EPNs have a significant correlation with adverse clinical outcomes in patients with ANP. The inclusion of these parameters, along with present scoring systems, will help further improve the prognostication of patients.

CT-Measured Fat &amp; Muscle Parameters: Impact on Acute Pancreatitis Severity

Aim: This study investigated whether Computed Tomography (CT)-measured abdominal fat and muscle parameters could improve the accuracy of acute pancreatitis (AP) severity assessment using the CT severity index (CTSI). Methods: This retrospective study included clinical and imaging parameters of 87 patients with AP. Asan J-Morphometry (Seoul, Korea), an ImageJ-based software (NIH, USA), was used to quantify abdominal muscle and fat areas. Total CTSI score, total fat area (TFA), superficial fat area (SFA), visceral fat area (VFA), total muscle area (MA) and total muscle-fat area (MFA) were calculated. Interreader agreement assessments, univariate and multivariate analyses were performed. Results:No significant differences were found in CT measurements between groups with or without systemic or local complications, or between groups categorized as mild and severe based on total CTSI scores (p &gt; 0.05 for all comparisons). Surgery, systemic complications, and a high total CTSI score significantly increased the risk of local complications, with odds ratios of 0.001, 141.9, and 2.42, respectively. With a cutoff of 4 or higher total CTSI score, the diagnostic performance of CTSI in assessing AP severity was as follows: sensitivity 81.25% (95% CI: 63.6-92.8), specificity 49.09% (95% CI: 35.4-62.9), positive predictive value 51% (95% CI: 42.7-59.2), negative predictive value 90% (95% CI: 74.8-96.5), and area under the ROC curve (AUC) 0.72 (95% CI: 0.61-0.81) (p &lt; 0.001). The intraclass correlation coefficients (ICC) were ≥ 0.90 between the readers. Conclusions: In this study, CT-measured fat and muscle parameters did not significantly improve the accuracy of CTSI in predicting severity of AP.

EP551 - Assessment of Surgical Management for Mild and Moderate Acute Gallstone Pancreatitis in Accordance with AUGIS Guidelines: A Clinical Audit

Abstract Aim Acute Gallstone Pancreatitis (AGSP) presents as a surgical emergency with diverse clinical outcomes. The guidelines from the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) recommend inpatient laparoscopic cholecystectomy (LC) during the index admission or within two weeks for surgically fit patients in cases of mild to moderate AGSP. This study examines the surgical management of AGSP, evaluating adherence to AUGIS guidelines. Methods All patients admitted to a single surgical unit who had MRCP for AGPS from September 2020 to September 2022 were included. Electronic case notes were reviewed for demographics, comorbidities, radiological results, whether they had LC and reasons for not proceeding to LC. Severity of AGSP were graded using CT severity index. Those with severe AGSP were excluded. Results 116 patients were identified; one was excluded. Median age was 59 years (IQR 46-73) and 79 (68.9%) were female. Median length of stay was 5.8 days (IQR 3.7-8.2). 19 (16.5%) patients had inpatient LC, 42 (36.5%) had outpatient LC, 4 (3.5%) patients declined LC, 10 (8.7%) patients were not surgically fit and in 40 (34.8%) patients there was no documentation of why LC not carried out. The median Charlson Comorbidity Index for patients where there was no documentations for not proceeding with LC was 4.5 (IQR 2.3-5.8). Conclusion Our study highlights suboptimal compliance with national guideline. It is essential that patients with AGSP undergo inpatient LC or receive prompt outpatient LC to mitigate the risk of recurrent AGSP. Thorough documentation becomes imperative in cases where LC is not scheduled.

Serum Claudin-5 levels facilitate the early prediction of severe acute pancreatitis: a prospective observational study

To investigate the value of early tight junction protein Claudin-5 levels in predicting the severity of acute pancreatitis (AP). A prospective observational study was conducted, including patients diagnosed with AP and admitted to the Northern Jiangsu People's Hospital from December 1, 2021 to November 30, 2022. Eligible healthy volunteers were randomly selected to serve as healthy controls during the same period. Patients were classified into mild acute pancreatitis (MAP) group, moderate-severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group based on the 2012 Atlanta classification criteria. Patients with SAP were then divided into three subgroups of 1, 3, and 7 days based on the duration of hospitalization. Baseline data, such as gender, age, underlying disease, and probable etiology, was collected from all enrolled individuals. The enzyme-linked immunosorbent assay (ELISA) was employed to detect serum Claudin-5 levels in each cohort of enrollees. Data on additional serologic indicators, including hematocrit (HCT), albumin (Alb), serum Ca2+, C-reactive protein (CRP), and procalcitonin (PCT) levels, were obtained via the in-hospital test query system in each group of patients with AP. The modified Marshall score (mMarshall), modified CT severity index (mCTSI) score, bedside severity index of severity in acute pancreatitis (BISAP) score, and acute physiology and chronic health evaluation II (APACHE II) were recorded for each group of patients with AP. Differences in the above indicators between groups were analyzed and compared. Spearman's correlation method was employed to examine the relationship between Claudin-5 levels and each influential factor. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each influencing factor on SAP. Ridge regression was used to screen for independent risk factors for SAP. A total of 109 patients with AP were enrolled, comprising 66 in the MAP group, 15 in the MSAP group, and 28 in the SAP group. Additionally, 27 healthy volunteers were enrolled as the healthy control group. No statistically significant differences were observed in gender and age among the enrolled groups, and no statistically significant differences were identified among the three groups of patients with AP in terms of underlying disease and etiologic composition. As the disease progressed, serum Claudin-5 levels exhibited a notable increase across all AP patient groups, and they were all significantly higher than those in the healthy control group [ng/L: 888.58 (574.52, 1 141.59), 3 749.02 (2 784.93, 5 789.92), 4 667.81 (3 935.21, 7 315.66) vs. 291.13 (250.19, 314.75), all P < 0.05]. Subgroup analyses showed that as the disease duration prolonged, patients in the SAP group exhibited a notable decline in Claudin-5 levels at 3 days post-admission, compared with those at 1 day post-admission [ng/L: 2 052.59 (1 089.43, 4 006.47) vs. 4 667.81 (3 935.21, 7 315.66), P < 0.05]. Spearman correlation analysis showed that serum Claudin-5 levels in patients with AP were significantly positively correlated with CRP, PCT, HCT, and mMarshall, mCTSI, and BISAP scores (r values were 0.570, 0.525, 0.323, 0.774, 0.670, 0.652, all P < 0.001), and significantly negatively correlated with Alb (r = -0.394, P < 0.001). A significant trend was observed in patients with AP, with an increase of HCT levels and a decrease of Alb levels as the disease progressed (both P < 0.05). An improvement of aforementioned phenomena was observed in patients with SAP following treatment, indirectly indicating that serum Claudin-5 level was a positive indicator of vascular leakage. ROC curve analysis showed that serum Claudin-5 levels in patients with AP exhibited the highest accuracy for early prediction of SAP, with the area under the ROC curve (AUC) of 0.948. When serum Claudin-5 levels ≥2 997 ng/L, the sensitivity for early screening for SAP was 100% and the specificity was 88.89%. Multifactorial ridge regression analysis showed that serum Claudin-5 level, PCT and APACHE II score could be used as independent risk factors for early prediction of SAP (all P < 0.05). Serum Claudin-5 levels facilitate early prediction of SAP and are strongly associated with inflammatory response and vascular leakage.

Clinical Outcomes of Diabetes Mellitus on Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis.

To analyze the influence of diabetes mellitus on the clinical outcomes of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). This retrospective study included patients diagnosed with MSAP and SAP at Shanxi Bethune Hospital from January 1, 2017, to December 31, 2021. Clinical data were collected, including patient demographics, 24-hour laboratory indicators, and inflammation indices. Propensity score matching (PSM) was used to compare outcomes before and after matching. Patients were randomized into training and validation sets (7:3) to develop and validate a clinical prediction model for infected pancreatic necrosis (IPN). Among 421 patients, 79had diabetes at admission. Before PSM, diabetic patients had higher incidences of peripancreatic fluid (71% vs 47%, p<0.001) and IPN (48% vs 10%, p<0.001), higher surgical intervention rates (24% vs 12%, p=0.008), and significant differences in abdominocentesis (22% vs 11%, p=0.014). After PSM, 174 patients were matched, and the diabetes group still showed higher incidences of peripancreatic fluid (69% vs 47%, p=0.008), IPN (48% vs 11%, p<0.001), and surgical intervention rates (27% vs 13%, p=0.037). Diabetes, modified CT severity index (MCTSI), serum calcium, and HDL-c were identified as independent risk factors for IPN. The prediction model demonstrated good predictive value. In MSAP and SAP patients, diabetes mellitus can exert an influence on their clinical outcome and is an independent risk factor for IPN. The alignment diagram and web calculator constructed on the basis of diabetes mellitus, modified CT severity index (MCTSI), serum calcium and high-density lipoprotein cholesterol (HDL-c) have good predictive value and clinical guidance for the occurrence of IPN in MSAP and SAP.

Correlation between the Predictive Accuracy of Computed Tomography Severity Index and Clinical Metrics in Acute Pancreatitis at a Tertiary Care Hospital Lahore

Correlation between the Predictive Accuracy of Computed Tomography Severity Index and Clinical Metrics in Acute Pancreatitis at a Tertiary Care Hospital Lahore

Development and validation of a nomogram based on Lasso-Logistic regression for predicting splenomegaly secondary to acute pancreatitis

PurposeInvestigate the clinical characteristics of splenomegaly secondary to acute pancreatitis (SSAP) and construct a nomogram prediction model based on Lasso-Logistic regression.MethodsA retrospective case-control study was conducted to analyze the laboratory parameters and computed tomography (CT) imaging of acute pancreatitis (AP) patients recruited at Xuanwu Hospital from December 2014 to December 2021. Lasso regression was used to identify risk factors, and a novel nomogram was developed. The performance of the nomogram in discrimination, calibration, and clinical usefulness was evaluated through internal validation.ResultsThe prevalence of SSAP was 9.2% (88/950), with the first detection occurring 65(30, 125) days after AP onset. Compared with the control group, the SSAP group exhibited a higher frequency of persistent respiratory failure, persistent renal failure, infected pancreatic necrosis, and severe AP, along with an increased need for surgery and longer hospital stay (P < 0.05 for all). There were 185 and 79 patients in the training and internal validation cohorts, respectively. Variables screened by Lasso regression, including platelet count, white blood cell (WBC) count, local complications, and modified CT severity index (mCTSI), were incorporated into the Logistic model. Multivariate analysis showed that WBC count ≦9.71 × 109/L, platelet count ≦140 × 109/L, mCTSI ≧8, and the presence of local complications were independently associated with the occurrence of SSAP. The area under the receiver operating characteristic curve was 0.790. The Hosmer-Lemeshow test showed that the model had good fitness (P = 0.954). Additionally, the nomogram performed well in the internal validation cohorts.ConclusionsSSAP is relatively common, and patients with this condition often have a worse clinical prognosis. Patients with low WBC and platelet counts, high mCTSI, and local complications in the early stages of the illness are at a higher risk for SSAP. A simple nomogram tool can be helpful for early prediction of SSAP.

A nomogram to predict the occurrence of pseudocyst in patients with acute pancreatitis

BackgroundPseudocyst formation is common in many patients with acute pancreatitis during follow-up. Many risk factors have been proposed to be associated with the development of PP, but the predictive factors are still underexplored. The focus of this study was to investigate whether early laboratory indicators could effectively predict the occurrence of PP. Methods2811 AP patients hospitalized in the Second Affiliated Hospital of Soochow University between November 2008 and September 2020 were retrospectively studied. Univariate and multivariate analyses were used to screen the risk variables. The nomograms of those risk factors were validated and evaluated by logistic analysis. ResultsAP patients had a 6.1 % (172/2811) incidence of PP. In a univariate analysis, the development of PP was correlated with serum lactate dehydrogenase (LDH), albumin (ALB), calcium (Ca), hemoglobin (Hb), organ dysfunction, CT severity index (CTSI), etiology, age, etc. Further logistic regression analysis showed that the risk factors were different between hyperlipidemic pancreatitis patients (LDH, ALB and Ca) and non-hyperlipidemic pancreatitis patients (LDH, Hb, ALB and Ca). A nomogram based on the identified risk factors was developed. Our model showed good discrimination ability, with a boostrap - corrected C index of 0.905 (95 % CI = 0.875–0.935), and had well-fitted calibration curves. The area under the curve (AUC) of the nomogram were 0.905 (95 % CI = 0.875–0.935) and 0.933 (95 % CI = 0.890–0.975) in the training and validation groups, respectively. The results of DCA indicated that the nomogram may have clinic usefulness. ConclusionsThe nomogram that incorporates early laboratory data (LDH, Hb, ALB, and Ca) in AP patients is able to predict the incidence of PP with greater accuracy than the CTSI and AP severity.

Application Value of the Automated Machine Learning Model Based on Modified Computed Tomography Severity Index Combined With Serological Indicators in the Early Prediction of Severe Acute Pancreatitis.

Machine learning (ML) algorithms are widely applied in building models of medicine due to their powerful studying and generalizing ability. To assess the value of the Modified Computed Tomography Severity Index (MCTSI) combined with serological indicators for early prediction of severe acute pancreatitis (SAP) by automated ML (AutoML). The clinical data, of the patients with acute pancreatitis (AP) hospitalized in Hospital 1 and hospital 2 from January 2017 to December 2021, were retrospectively analyzed. Serological indicators within 24 hours of admission were collected. MCTSI score was completed by noncontrast computed tomography within 24 hours of admission. Data from the hospital 1 were adopted for training, and data from the hospital 2 were adopted for external validation. The diagnosis of AP and SAP was based on the 2012 revised Atlanta classification of AP. Models were built using traditional logistic regression and AutoML analysis with 4 types of algorithms. The performance of models was evaluated by the receiver operating characteristic curve, the calibration curve, and the decision curve analysis based on logistic regression and decision curve analysis, feature importance, SHapley Additive exPlanation Plot, and Local Interpretable Model Agnostic Explanation based on AutoML. A total of 499 patients were used to develop the models in the training data set. An independent data set of 201 patients was used to test the models. The model developed by the Deep Neural Net (DL) outperformed other models with an area under the receiver operating characteristic curve (areas under the curve) of 0.907 in the test set. Furthermore, among these AutoML models, the DL and gradient boosting machine models achieved the highest sensitivity values, both exceeding 0.800. The AutoML model based on the MCTSI score combined with serological indicators has good predictive value for SAP in the early stage.

Comparative analysis of computed tomography severity indices in predicting the severity and clinical outcome in patients with acute pancreatitis.

Background: Acute pancreatitis (AP) has unpredictable severity. Its management is based on initial assessment of disease severity. It ranges from mild interstitial to severe necrotic form; the latter is associated with poor prognosis. Contrast-enhanced computed tomography (CT) of the abdomen is the gold standard in early detection of pancreatic necrosis and inassessing the severity ofAP. Two CTgrading systems exist to assess theseverity of AP: CT severity Index (CSI) and modified CSI (MCSI). This study compares the usefulness of these two systems in predicting theseverity and clinical outcome in AP in comparisonwith Ranson's criteria and clinical outcome parameters. Methods: This is a prospective hospital-based screening study of 80 patients aged >12 years with clinical diagnosis of AP who underwent contrast-enhanced CT study of the abdomen. Comparative analysis between MCSI and CSI with Ranson's criteria and clinical outcome parameters was assessed by Chi-Squared test. Results: The accuracy ofCSI and MCSI in predicting the requirement of critical care, superadded infection, multiple organ dysfunction syndrome (MODS) and requirement of intervention were 73.0%, 64.5%, 69.8% 60.9% and 77.2%, 76.0%, 74.4% & 56.6% respectively. Area under the curve for MCSI score was significantly higher (AUC: 0.861; 95% CI: 0.736-0.986) than CSI score (AUC:0.815;95% CI:0.749-0.941). MCSI and CSI showed significant correlation with Ranson's criteria; however, MCSI correlation was better (r:0.53; p<0.01) than CSI (r:0.35;p:0.04). Conclusion: CSI and MCSI are better predictors of severity, clinical outcome and mortality compared with Ranson's criteria, with MCSI being more accurate and better predictor than CSI. The accuracy of MCSI is better than CSI for prediction of requirement of critical care, development of superadded infection and development of MODS in AP. However, CSI and MCSI have low accuracy in predicting intervention in AP.

Early detection of necrosis in low-enhanced pancreatic parenchyma using contrast-enhanced computed tomography was a better predictor of clinical outcomes than pancreatic inflammation: A multicentric cohort study of severe acute pancreatitis

ObjectivesWe aim to assess the early use of contrast-enhanced computed tomography (CECT) of patients with severe acute pancreatitis (SAP) using the computed tomography severity index (CTSI) in prognosis prediction. The CTSI combines quantification of pancreatic and extrapancreatic inflammation with the extent of pancreatic necrosis. MethodsPost-hoc retrospective analysis of a large, multicentric database (44 institutions) of SAP patients in Japan. The area under the curve (AUC) of the CTSI for predicting mortality and the odds ratio (OR) of the extent of pancreatic inflammation and necrosis were calculated using multivariable analysis. ResultsIn total, 1097 patients were included. The AUC of the CTSI for mortality was 0.65 (95 % confidence interval [CI:] [0.59–0.70]; p < 0.001). In multivariable analysis, necrosis 30–50 % and >50 % in low-enhanced pancreatic parenchyma (LEPP) was independently associated with a significant increase in mortality, with OR 2.04 and 95 % CI 1.01–4.12 (P < 0.05) and OR 3.88 and 95 % CI 2.04–7.40 (P < 0.001), respectively. However, the extent of pancreatic inflammation was not associated with mortality, regardless of severity. ConclusionsThe degree of necrosis in LEPP assessed using early CECT of SAP was a better predictor of mortality than the extent of pancreatic inflammation.

A clinical study correlating the serum levels of lactate dehydrogenase, C-reactive protein, and lipase with the severity and related complications of acute pancreatitis

ABSTRACT Background: In addition to Ranson’s criteria, computed tomography severity index (CTSI), and Acute Physiology and Chronic Health Evaluation II score, the presence of local or systemic complications can predict severe acute pancreatitis (AP). However, proper evaluation by these one-time scores is available after 48 h following admission. Aims and Objectives: This study aims to correlate AP severity and related consequences with serum levels of lipase, C-reactive protein (CRP), and lactate dehydrogenase (LDH). Methods: A prospective analysis was performed on 60 patients with AP who were admitted to the surgical unit. Data on patients’ clinical and radiological evaluations, serum levels of CRP, LDH, and lipase, as well as hematological tests, were gathered and examined. Results: The most common cause of AP, gallstone pancreatitis, affected adults between the ages of 30 and 55, with a female predominance (56.67%). According to the Chi-square test, there was a significant correlation between the Ranson’s score and the CTSI. Similar to this, a very high test of significance for serum CRP levels (&gt;150 mg/l) was seen with both Ranson’s score and the CTSI. Only 15% of patients had severe AP, whereas 85% of cases had mild AP. The majority of the patients (93.4%) recovered with supportive medical care, four (6.7%) needed surgery (necrosectomy/drainage), and one (1.6%) died. Conclusion: The serum CRP level is a good predictor of severe AP. It can be used as an early severity indicator along with the CTSI.

Clinical study of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hypertriglyceridemia-induced acute pancreatitis and acute biliary pancreatitis with persistent organ failure.

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory indicators that can be used to predict the severity and prognosis of various diseases. We categorize acute pancreatitis by etiology into acute biliary pancreatitis (ABP) and hypertriglyceridemia-induced acute pancreatitis (HTGP). To investigate the clinical significance of NLR and PLR in assessing persistent organ failure (POF) in HTGP and ABP. A total of 1450 patients diagnosed with acute pancreatitis (AP) for the first time at Shanxi Bethune Hospital between January 2012 and January 2023 were enrolled. The patients were categorized into two groups according to the etiology of AP: ABP in 530 patients and HTGP in 241 patients. We collected and compared the clinical data of the patients, including NLR, PLR, and AP prognostic scoring systems, within 48 h of hospital admission. The NLR (9.1 vs 6.9, P < 0.001) and PLR (203.1 vs 160.5, P < 0.001) were significantly higher in the ABP group than in the HTGP group. In the HTGP group, both NLR and PLR were significantly increased in patients with severe AP and those with a SOFA score ≥ 3. Likewise, in the ABP group, NLR and PLR were significantly elevated in patients with severe AP, modified computed tomography severity index score ≥ 4, Japanese Severity Score ≥ 3, and modified Marshall score ≥ 2. Moreover, NLR and PLR showed predictive value for the development of POF in both the ABP and HTGP groups. NLR and PLR vary between ABP and HTGP, are strongly associated with AP prognostic scoring systems, and have predictive potential for the occurrence of POF in both ABP and HTGP.

Prevalence, treatment efficacy, and risk factors of vascular complications in acute pancreatitis: A case-control study.

We aimed to investigate the prevalence of vascular complications in acute pancreatitis (AP), to compare patient outcomes using various treatments, and to explore the related risk factors. Consecutive AP patients admitted from January 2010 to July 2017 were retrospectively included. Demographics, vascular complications, laboratory indices, and imaging findings were collected. Univariate and multivariate analyses were used to explore potential risk factors of vascular complications. Of 3048 AP patients, 808 (26.5%) had vascular complications, including visceral vein thrombosis, sinistral portal hypertension, and arterial complications. And 38 (4.7%) patients received anticoagulant therapy and had a higher rate of recanalization (P < 0.001). Bleeding occurred in 95 (11.8%) patients, who received further treatment. Multivariate analysis identified male gender (odds ratio [OR] 1.650, 95% confidence interval [CI] 1.101-2.472), hyperlipidemia (OR 1.714, 95% CI 1.356-2.165), disease recurrence (OR 3.727, 95% CI 2.713-5.118), smoking (OR 1.519, 95% CI 1.011-2.283), hemoglobin level (OR 0.987, 95% CI 0.981-0.993), white blood cell (WBC) count (OR 1.094, 95% CI 1.068-1.122), non-vascular local complications (OR 3.018, 95% CI 1.992-4.573), computed tomography severity index (CTSI) (OR 1.425, 95% CI 1.273-1.596), and acute physiology and chronic health evaluation (APACHE) II score (OR 1.057, 95% CI 1.025-1.090) were related to vascular complications. Vascular complications in AP is prevalent and their treatment is challenging. Further investigations are warranted to determine the optimal treatment strategy. Independent risk factors included male gender, hyperlipidemia, disease recurrence, smoking, WBC count, non-vascular local complications, CTSI, and APACHE II score.

A COMPARATIVE STUDY OF ULTRASOUND AND COMPUTED TOMOGRAPHY IN EVALUATION OF ACUTE AND CHRONIC PANCREATITIS, ASSOCIATED COMPLICATIONS AND PREDICTING SEVERITY AND PROGNOSIS

Objectives: (1) The objective of the study was to determine the value of USG and computed tomography (CT) in early diagnosis of acute pancreatitis (AP). (2) The study aimed to compare which of the above two radiological investigations (USG/CT) provides the most important information of the disease process and to determine value of CT in evaluating complications, morbidity/severity, and predicting prognosis of AP using modified CT severity index (MCTSI). Methods: This study included 50 patients diagnosed with pancreatitis, consisting of 38 cases of AP and 12 cases of chronic pancreatitis (CP). Both USG and contrast-enhanced CT (CECT) were used to visualize the pancreas, assess its size, detect peripancreatic inflammation and fluid collections, and identify the extent of necrosis and complications. The sensitivity and specificity of USG and CECT were compared. The severity of AP was classified using the MCTSI within 3 days of symptom onset. Clinical outcomes, including hospital stay duration, organ failure, systemic infection, and the need for surgical intervention, were recorded and correlated with MCTSI scores. Statistical Package for the Social Sciences 22.0 was used for statistical analysis and p&lt;0.05 was taken as statistically significant. Results: The mean age of patients was 37.92±12.14 years. USG had a sensitivity of 58% for detecting AP, significantly lower than the 95% sensitivity of CECT, primarily due to bowel gas interference. Both USG and CECT had high positive predictive values. The MCTSI effectively classified the severity of AP, with 41.5% of cases categorized as mild, 39% as moderate, and 19.5% as severe. Extrapancreatic complications were significantly correlated with adverse clinical outcomes and end-organ failure when included in the MCTSI scoring. USG was adequate for diagnosing CP through visualization of dilated ducts, calcifications, and atrophic pancreas, but CECT demonstrated higher specificity and accuracy, especially for rare forms like groove and mass-forming pancreatitis. The study showed a strong correlation between MCTSI scores and patient outcomes. The mortality rate was 2%, observed only in patients with severe AP. Conclusion: The MCTSI is a valuable tool for accurately classifying the severity of AP and predicting clinical outcomes. CECT is superior to USG in diagnosing and managing pancreatitis, providing better visualization and assessment of complications. While USG is useful for diagnosing CP, CECT offers greater specificity and accuracy. The study supports the use of MCTSI in routine clinical practice to guide the management and predict outcomes in patients with AP.