Computed Tomography Severity Index Score Research Articles

Acute pancreatitis associated with pleural effusion: MDCT manifestations and anatomical basis.

Acute pancreatitis (AP) is a severe condition with complications that can impact multiple organ systems throughout the body. Specifically, the diffusion of peripancreatic effusion to the pleural cavity is a significant phenomenon in AP. However, its pathways and implications for disease severity are not fully understood. This study aims to investigate the anatomical routes of peripancreatic effusion diffusion into the pleural cavity in patients with AP and to analyze the correlation between the severity of pleural effusion (PE) and the computed tomography severity index (CTSI) and acute physiology and chronic health evaluation II (APACHE II) scoring system. 119 patients with AP admitted to our institution were enrolled in this study (mean age 50 years, 74 male and 45 female). Abdominal CT was performed, and the CTSI and APACHE II index were used to evaluate the severity of the AP, Meanwhile, the prevalence and semiquantitative of PE were also mentioned. The anatomical pathways of peripancreatic effusion draining to pleural were analyzed. Finally, the correlation relationship between the severity of AP and the PE was analyzed. In 119 patients with AP, 74.8% of patients had PE on CT. The anatomic pathways of peripancreatic effusion draining to pleural included esophageal hiatus in 33.7% of patients, aortic hiatus in 6.7% of patients and inferior vena cava hiatus in 3.37% of patients. The rating of PE on CT was correlated with CTSI scores (r= 0.449, P= 0.000) and was slightly correlated with the APACHE II scores (r= 0.197, P= 0.016). PE is a common complication of AP, which can be caused by anatomic pathways such as diaphragmatic hiatus. Due to its correlation with the CTSI score, the PE may be a supplementary indicator in determining the severity of AP.

Nomogram for the prediction of infected pancreatic necrosis in moderately severe and severe acute pancreatitis.

As a serious complication of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) can lead to a prolonged course of interventional therapy. Most predictive models designed to identify such patients are complex or lack validation. The aim of this study was to develop a predictive model for the early detection of IPN in MSAP and SAP. A total of 594 patients with MSAP or SAP were included in the study. To reduce dimensionality, least absolute shrinkage and selection operator regression analysis was used to screen potential predictive variables, a nomogram was then constructed using logistic regression analysis. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, accuracy, and clinical efficacy of the model. External data were also obtained to further validate the constructed model. There were 476, 118, and 82 patients in the training, internal validation, and external validation cohorts, respectively. Platelet count, hematocrit, albumin/globulin, severity of acute pancreatitis, and modified computed tomography severity index score were independent factors for predicting IPN in MSAP and SAP. The area under the ROC curves were 0.923, 0.940, and 0.817, respectively, in the three groups. There was a good consistency between the actual probabilities and the predicted probabilities. DCA revealed excellent clinical utility. The constructed nomogram is a simple and feasible model that has good clinical predictive value and efficacy in clinical decision-making for IPN in MSAP and SAP.

Quantitative T2 Mapping of Acute Pancreatitis.

Quantification of the T2 signal by means of T2 mapping in acute pancreatitis (AP) has the potential to quantify the parenchymal edema. Quantitative T2 mapping may overcome the limitations of previously reported scoring systems for reliable assessment of AP. To evaluate MR-derived pancreatic T2 mapping values in AP and correlate them with markers of disease severity. Prospective single-center study. 76 adults with AP (20-91 years, females/males: 39/37). Fat suppressed multiecho spin-echo prototype sequence to quantify T2 signal at 3T MRI. The severity of AP was assessed clinically, biologically, and by contrast-enhanced CT (CECT) performed 48-72 hours after symptom onset. MRI was then performed ≤24 hours after CT. Two readers blinded to any clinical information independently evaluated the T2 values by placing three regions of interest inside the pancreatic head, body, and tail on the T2 mapping MR sequence. Results were compared with corresponding CECT images as the standard and clinical severity parameters, using the length of hospital stay as our primary endpoint. Continuous variables were compared using the Spearman's rank correlation coefficient, analysis of variance (ANOVA) or Student's t-test. T2 values significantly correlated with the length of hospital stay (rs (74) = 0.29), CT severity index (CTSI) (rs (73) = 0.61; CTSI 0-3: 72 ± 14 msec, CTSI 4-10: 88 ± 15), intensive care unit (ICU) admission (t(2.77) = -3.41) and presence of organ failure (t(6.72) = -3.42), whereas the CTSI and Ranson score were not significantly related with ICU admission (CTSI: P = 0.24; Ranson score: P = 0.24) and organ failure (CTSI: P = 0.11; Ranson score P = 0.11). T2 mapping correlates with AP severity parameters and is useful for assessing the severity of AP with higher sensitivity than the usual clinical and radiological scoring systems. 1 TECHNICAL EFFICACY: Stage 2.

Clinical Significance of Serum CTRP3 Level in the Prediction of Cardiac and Intestinal Mucosal Barrier Dysfunction in Patients with Severe Acute Pancreatitis.

C1q/tumor necrosis factor-related protein 3 (CTRP3) has been demonstrated to play a protective role in mice with severe acute pancreatitis (SAP). However, its clinical significance in SAP remains unknown. This study was conducted to explore the clinical values of serum C1q/tumor necrosis factor-related protein 3 (CTRP3) level in the diagnosis of cardiac dysfunction (CD) and intestinal mucosal barrier dysfunction (IMBD) in SAP. Through RT-qPCR, we observed decreased CTRP3 level in the serum of SAP patients. Serum CTRP3 level was correlated with C-reactive protein, procalcitonin, creatine, modified computed tomography severity index score, and Acute Physiology and Chronic Health Evaluation II score. The receiver-operating characteristic curve revealed that CTRP3 serum level < 1.005 was conducive to SAP diagnosis with 72.55% sensitivity and 60.00% specificity, CTRP3 < 0.8400 was conducive to CD diagnosis with 80.49% sensitivity and specificity 65.57%, CTRP3 < 0.8900 was conducive to IMBD diagnosis with 94.87% sensitivity and 63.49% specificity, and CTRP3 < 0.6250 was conducive to the diagnosis of CD and IMBD co-existence with 65.22% sensitivity and 89.87% specificity. Generally, CTRP3 was downregulated in the serum of SAP patients and served as a candidate biomarker for the diagnosis of SAP and SAP-induced CD and IMBD.

Correlation of serum ferritin, LDH, CRP with chest findings- CT severity index in COVID-19 patients

Background: The COVID-19 pandemic is caused by a highly infectious virus primarily transmitted from person to person. The initial clinical manifestations of the condition are non-specific, characterized by the presence of fever and cough. These symptoms may resolve independently or escalate to acute respiratory distress syndrome (ARDS), multiple organ failure, and ultimately, mortality. Methods: The research was conducted at Moolchand Khairatiram Hospital in the COVID-19 wards and ICU in New Delhi. The blood samples were collected and then analyzed to evaluate the following parameters: C-reactive protein (CRP), serum ferritin, and LDH are the three biomarkers of interest. The statistical significance threshold was established at a p value of less than 0.05. Results: The study included 200 patients, 49% of whom were male and 51% of whom were female. A link was discovered between the outcome and the CT severity index. Patients who had a CT severity index of 21-25 died at the highest rate. The CT severity index and ferritin were found to have a significant relationship, with patients with elevated ferritin levels reporting the highest CT severity index scores. Conclusions: A statistically significant association was observed between the CT severity index and the outcome, with the highest mortality rate observed in patients who had a CT severity index of 21-25. The parameters above are crucial in assessing the condition and predicting the outcome of individuals afflicted with COVID-19.

The predictive value of CTSI scoring system in non-operative management of patients with splenic blunt trauma: The experience of a level 1 trauma center

BackgroundThe spleen is one of the most injured organs following blunt abdominal trauma. The management options can be either operative or non-operative management (NOM) with either conservative management or splenic artery embolization. The implementation of CT in emergency departments allowed the use of CT imaging as a primary screening tool in early decision-making. Consecutively, new splenic injury scoring systems, such as the CT severity index (CTSI) reported was established. AimThe main aim of this study is to evaluate the effect of the implementation of CTSI scoring system on the management decision and outcomes in patients with blunt splenic trauma over 8 years in a level 1 trauma center. MethodsThis is a retrospective study including all adult patients with primary splenic trauma, having NOM and admitted to our hospital between 2013 and 2021. ResultsThe analyses were conducted on ninety-nine patients. The average sample age was 32.7 ± 12.3 years old. A total of (63/99) patients had splenic parenchyma injury without splenic vascular injury. There is a statistically significant association between CTSI grade 3 injury and the development of delayed splenic vascular injury (p < 0.05). There is an association between severity of initial CTSI score and the risk of NOM/clinical failure (p = 0.02). ConclusionOur findings suggest implementing such a system in a level 1 trauma center will further improve the outcome of treatment for splenic blunt trauma. However, CTSI grade 3 is considered an increased risk of NOM failure, and further investigations are necessary to standardize its management.

CT Features of Recurrent Acute Pancreatitis: Early Phase Versus Late Phase.

The aim of this study was to investigate the computed tomography (CT) features of recurrent acute pancreatitis (RAP) in the early phase and late phase. Recurrent acute pancreatitis data were obtained over the past 5 years. Recurrent acute pancreatitis patients were divided into 2 groups according to the time from RAP onset to performing CT examination: the early phase (first week) and late phase (after the first week) based on the 2012 revised Atlanta classification (RAC). Evaluation and comparison of patients' demographic data, RAC, CT findings, CT severity index (CTSI) score, and extrapancreatic inflammation on CT (EPIC) score were conducted in the 2 groups. Hypertriglyceridemia was the most common cause of RAP in 679 of 686 patients (positive CT rate: 98.98%). Among 679 CT-positive patients, interstitial edematous pancreatitis and necrotizing pancreatitis accounted for 61.71% (419/679) and 38.29% (260/679), respectively. The CTSI and EPIC scores were higher in the late phase than in the early phase (both P 's < 0.05). The proportion of moderately severe and severe RAP patients based on RAC was higher in the late phase than in the early phase ( P < 0.05). Early-stage EPIC score was more accurate than CTSI and Acute Physiology and Chronic Health Evaluation (APACHE) II scores in predicting clinically severe RAP (EPIC vs CTSI; EPIC vs APACHE II, both P 's < 0.05). Recurrent acute pancreatitis is more severe in the late phase than in the early phase. The EPIC score is more indicative of clinically severe RAP than CTSI and APACHE II scores in the early phase of RAP.

CT characteristics of recurrent acute pancreatitis and acute pancreatitis in different stages-a retrospective cross-sectional study.

Acute pancreatitis (AP), recurrent acute pancreatitis (RAP), and chronic pancreatitis (CP) are a continuum of the same disease. The course of RAP and AP is a dynamic process. Previous studies are contradictory regarding the severity of RAP and AP. We conducted this study to investigate the computed tomography (CT) characteristics of RAP and AP in the early and late stages; respectively. Patients who underwent contrast-enhanced computed tomography for symptoms during RAP or AP episodes were retrospectively collected from three tertiary hospitals in Sichuan Province, China from January 2015 to December 2019. The patients were categorized into RAP and AP groups based on recurrence and initial events. Both the RAP and AP groups were divided into early (first week) and late stages (after the first week) based on the 2012 revised Atlanta classification (RAC). Patient demographic data, RAC, CT findings, CT severity index (CTSI) scores, and extrapancreatic inflammation on CT scores in the early and late phases were analyzed between the two groups. The Wilcoxon signed-rank test, χ2 test, and Fisher's exact test were used to compare continuous and categorical variables between the two groups respectively. In 683 RAP and 1,829 AP patients, the most common etiologies were hypertriglyceridemia and cholelithiasis, respectively. The RAP group had lower extrapancreatic inflammation on CT scores and Acute Physiology and Chronic Health Evaluation II scores than the AP group in the early stage (both P<0.001). The RAP group had higher CTSI scores than the AP group in the late stage (P=0.022). Compared with AP patients, the most common cause of RAP patients was hypertriglyceridemia in China, and the severity of RAP was lower than that of initial AP in the early stage and higher than that of initial AP in the late stage.

The relationship of biochemical parameters and radiological parameters in the evaluation of the clinical severity of acute pancreatitis in the emergency department – a retrospective analysis

Introduction and aim. Computed tomography severity index (CTSI) and Balthazar score are among the most frequently used scorings in the determination of severe acute pancreatitis. The primary purpose of this study is evaluation of the effects of biochemical parameters, Balthazar score and CTSI on mortality in acute pancreatitis. At the same time, correlations with biochemical parameters, CTSI and Balthazar score were evaluated in patients with AP. Material and methods. In this study, the amylase, lipase, CRP, and procalcitonin values of ​​ patients diagnosed with acute pancreatitis were retrospectively recorded. Contrast-enhanced computed tomography (CECT) images obtained at the time of presentation to the emergency department or within seven days of admission were re-evaluated by two radiologists. The CTSI scores and Balthazar scores of the patients were calculated. Results. The study included 240 patients. The amylase level of the patients was positively correlated with the Balthazar score at a statistically significant level (R=0.189, p=0.003). In addition,, the relationship between pancreatic scoring systems and mortality, the AUC value for CTSI was 0.9 (95% CI: 0.826-0.973) and was higher than other scoring systems. Conclusion. CTSI had better performance in the prediction of mortality in patients with acute pancreatitis.

The severity and infection of acute pancreatitis may increase the risk of bleeding in patients undergoing EUS-guided drainage and endoscopic necrosectomy: a large retrospective cohort.

There has been great progress in the use of endoscopic ultrasound (EUS)-guided drainage in acute pancreatitis patients using a novel lumen-apposing metal stent (LAMS) in the last decade, but some patients experience bleeding. Our research analyzed the preprocedural risk factors for bleeding. From July 13, 2016 to June 23, 2021, we retrospectively analyzed all patients who received endoscopic drainage by the LAMS in our hospital. Univariate and multivariate statistical analyses were used to identify the independent risk factors. We plotted ROC curves based on the independent risk factors. A total of 205 patients were analyzed and 5 patients were excluded. A total of 200 patients were included in our research. Thirty (15%) patients presented with bleeding. In the multivariate analysis, computed tomography severity index score (CTSI) score [odds ratio (OR), 2.66; 95% CI: 1.31-5.38; P = 0.007], positive blood cultures [odds ratio (OR), 5.35; 95% CI: 1.31-21.9; P = 0.02], and Acute Physiology and Chronic Health Evaluation II (APACHE II) score [odds ratio (OR), 1.14; 95% CI: 1. 01-1.29; P = 0.045] were associated with bleeding. The area under the ROC curve of the combined predictive indicator was 0.79. Bleeding in endoscopic drainage by the LAMS is significantly associated with the CTSI score, positive blood cultures, and APACHE II score. This result could help clinicians make more appropriate choices.

Evaluation of Inflammatory Infiltration in the Retroperitoneal Space of Acute Pancreatitis Using Computer Tomography and Its Correlation with Clinical Severity.

This paper investigates the correlation between the degree and severity of CT inflammatory infiltration in the retroperitoneal space of acute pancreatitis (AP). A total of 113 patients were included based on diagnostic criteria. The general data of the patients and the relationship between the computed tomography severity index (CTSI) and pleural effusion (PE), involvement, degree of inflammatory infiltration of retroperitoneal space (RPS), number of peripancreatic effusion sites, and degree of pancreatic necrosis on contrast-enhanced CT at different times were studied. The results showed that the mean age of onset in females was later than that in males; 62 cases involved RPS to varying degrees, with a positive rate of 54.9% (62/113), and the total involvement rates of only the anterior pararenal space (APS); both APS and perirenal space (PS); and APS, PS, and posterior pararenal space (PPS) were 46.9% (53/113), 53.1% (60/113), and 17.7% (20/113), respectively. The degree of inflammatory infiltration in the RPS worsened with the increase in CTSI score; the incidence of PE was higher in the group greater than 48 hours than in the group less than 48 hours; necrosis >50% grade was predominant (43.2%) 5 to 6 days after onset, with a higher detection rate than other time periods (P < 0.05). Thus, when the PPS was involved, the patient's condition can be treated as severe acute pancreatitis (SAP); the higher the degree of inflammatory infiltration in the retroperitoneum, the higher the severity of AP. Enhanced CT examination 5 to 6 days after onset in patients with AP revealed the greatest extent of pancreatic necrosis.

Elevated serum HbA1c level, rather than previous history of diabetes, predicts the disease severity and clinical outcomes of acute pancreatitis

IntroductionThe aim of our study is to explore the value of serum glycosylated hemoglobin A1c (HbA1c) in disease severity and clinical outcomes of acute pancreatitis (AP).Research design and MethodsPatients with...

Value of Dual-Energy CT Perfusion Analysis in Patients with Acute Pancreatitis: Correlation and Discriminative Diagnostic Accuracy with Varying Disease Severity.

This study investigates the correlation and discriminative diagnostic accuracy of dual-energy CT (DECT)-derived imaging biomarkers in patients with acute pancreatitis of varying severity. In this retrospective study, we included 51 patients with acute pancreatitis who had undergone portal-venous phase DECT of the abdomen. Three blinded readers independently performed region-of-interest measurements on DECT images in the inflammatory pancreatic parenchyma. The correlation between modified CT severity index (CTSI) and quantitative imaging parameters was investigated using Pearson correlation coefficient. We performed receiver operator curve (ROC) analysis to assess diagnostic accuracy of the quantitative image parameters for the differentiation between mild/moderate versus severe acute pancreatitis. The optimal discriminative cut-off value to diagnose severe acute pancreatitis was determined using the Youden index. Moderate correlations were found between CTSI scores and iodine density (Pearson's correlation coefficient r = -0.65; p &lt; 0.001), as well as attenuation (r = -0.55; p &lt; 0.001) and normalized iodine uptake (r = -0.50; p &lt; 0.001). ROC curve analysis revealed highest ability to differentiate mild/moderate from severe acute pancreatitis for iodine density (AUC = 0.86, 95% confidence interval 0.75 to 0.97). An optimal iodine density threshold of ≤1.63 mg/mL was found to indicate severe acute pancreatitis with a sensitivity of 81.3% and specificity of 77.1%. DECT-derived iodine density correlates with acute pancreatitis severity and may facilitate prediction of severe acute pancreatitis.

Evaluation of the effect of pancreatic volume on mortality in patients with acute pancreatitis

BackgroundPancreatic volume is enlarged in acute pancreatitis. ObjectiveThis study aimed to evaluate whether there was a difference in pancreatic volume between survivors and non-survivors with acute pancreatitis using computer-generated 3D imaging. MethodThis single-center retrospective observational cohort study was conducted between January 2015 and December 2020. The hospital automation system was used to get the patients diagnosed with acute pancreatitis by using International Classification of Diseases (ICD) (ninth edition, code 577.0 or 10th version, code K 85.0) codes. The patients' pancreatic volumes, computed tomography severity index (CTSI), and modified computed tomography severity index (mCTSI) scores were calculated using the data obtained from the hospital automation system. The pancreatic volumes of the patients were measured using the computer-generated 3D imaging method. Pancreatic volume, CTSI, and mCTSI were then statistically compared in terms of mortality prediction by using the receiver operating characteristic (ROC) analysis. ResultsOf the 143 patients, 57.34% were female and 42.66% were male. The cut-off value of pancreatic volume in determining mortality was>81.5 cm3 OR:17.43 (%95 CI: 2.2–138.1) Cohen's d:1.126, at which it had 92.3% sensitivity, 60.0% specificity, 18.8% positive predictive value, and 98.7% negative predictive value. As a result of the ROC analysis of pancreatic volume in mortality prediction, the area under curve (AUC) value was determined as 0.787 [95% confidence interval (CI): 0.711–0.851]. The ROC analysis of the CTSI and mCTSI scores in mortality prediction revealed AUC values of 0.822 (95%CI: 0.750–0.881) and 0.955 (95%CI: 0.907–0.983) respectively. ConclusionAlthough CTSI scores pancreatic enlargement and mCTSI scores pancreatic necrosis and inflammation, the pancreatic volume value is not clearly scored in both. In this study population, pancreatic volume above 81.5 cm was associated with increased mortality. Both CTSI and mCTSI scores outperformed pancreatic volume in predicting mortality.

Clinical profile of acute pancreatitis and the application of different severity indices in patients treated at Rehman Medical Institute, Peshawar

Background: Acute Pancreatitis (AP) is the inflammation of the pancreas. Based on the severity of the disease, one can easily manage it, for this purpose certain scoring systems, such as Ranson’s Score, Glasgow Score and modified CT Severity Index Score are being used to predict the severity and prognosis of AP. Objectives: The objective of our study is to assess the efficacy of various severity indices (Ranson’s score, Glasgow score, Modified CT severity index score) in predicting the prognosis of patients. Methodology: This retrospective study was conducted in the Dept of Medicine at Rehman Medical Institute, Peshawar, between May 2021 to September 2021 after approval from the Department of Research, Rehman Medical College. Data was retrieved from the patients’ records on a structured proforma. Those with a definitive diagnosis and were treated for acute pancreatitis in the past 5 years, were included in the study. Results: CT Severity Index Score found that out of 35 males, 10 (28%) had mild, 16 (45%) had moderate and only 9 (25%) had severe pancreatitis. Whereas out of the 34, only 5 (14%), 17 (50%) and 12 (35%) females had mild, moderate and severe disease respectively.

WE8.4 Acute Pancreatitis during COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in Western Health and Social Care Trust (Altnagelvin Area Hospital)

BackgroundAcute pancreatitis is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. COVID-19 pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, primary aim was to ascertain incidence of COVID-19 in acute pancreatitis patients.MethodsA retrospective observational review of all patients admitted under General Surgical team from March 2020 till September 2020 was performed. Information regarding demographics, severity of acute pancreatitis (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected.ResultsForty four (44) patients were admitted with acute pancreatitis. Only one patient (2.3%) was diagnosed with COVID-19 at time of pancreatitis. Aetiology of pancreatitis was found comparable to aetiology reported by large scale studies (2). Mortality was 7% (3 patients). Five patients (11%) needed ICU admission due to organ dysfunction. Three patients (7%) developed ARDS.ConclusionsThe overall incidence of COVID-19 in pancreatitis in our population of study was low. Therefore, results were compared to patients who were COVID-19 negative in COVID-PAN study. Patients with acute pancreatitis in our target population were mostly elderly, about one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As has been observed in other centres globally, urgent for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4/19 patients having undergone interval cholecystectomy.

Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study.

BACKGROUNDThe incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased yearly, but updated population-based estimates on the incidence of HTG-AP are lacking. Reducing serum triglyceride (TG) levels quickly is crucial in the early treatment of HTG-AP. Decreased serum TG levels are treated by non-invasive methods, which include anti-lipidemic agents, heparin, low-molecular weight heparin, and insulin, and invasive methods, such as blood purification including hemoperfusion (HP), plasmapheresis, and continuous renal replacement therapy. However, authoritative guidelines have not been established. Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.AIMTo evaluate the effect between patients treated with intravenous insulin (INS) and HP to guide clinical treatment.METHODSWe retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP. Propensity score matching was used to compare the clinical outcomes of INS and HP.RESULTSA total of 371 patients met the HTG-AP criteria. The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years (8.4% in April 2012-March 2013 and 22.3% in April 2020-March 2021). The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years. The amylase level was elevated in 80.1% of patients but was only three times the normal value in 46.9% of patients. The frequency of severe acute pancreatitis (26.9%), organ failure (31.5%), rate of recurrence (32.9%), and mortality (3.0%) of HTG-AP was high. Improved Marshall score, modified computed tomography severity index score, baseline TG, baseline amylase, C-reactive protein (CRP), albumin, aspartate aminotransferase, low-density lipoprotein cholesterol, urea nitrogen, creatinine, calcium, hemoglobin, free triiodothyronine, admission to intensive care unit, and mortality were significantly different between patients with different grades of severity (P < 0.050). Multivariate logistic regression analysis confirmed that high CRP [P = 0.005, odds ratio (OR) = 1.011, 95%CI: 1.003-1.019], low calcium (P = 0.003, OR = 0.016, 95%CI: 0.001-0.239), and low albumin (P = 0.023, OR = 0.821, 95%CI: 0.693-0.973) were risk factors of severe HTG-AP. After propensity score matching adjusted by sex, age, severity of HTG-AP, and baseline TG, the serum TG significantly decreased in patients treated with INS (P < 0.000) and HP (P < 0.000) within 48 h. However, the clearance rate of TG (57.24 ± 33.70% vs 56.38 ± 33.61%, P = 0.927) and length of stay (13.04 ± 7.92 d vs 12.35 ± 6.40 d, P = 0.730) did not differ between the two groups.CONCLUSIONThe incidence of HTG-AP exhibited a significant increase, remarkable severity, and recurrent trend. Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

Evaluation of severity and prognosis of acute pancreatitis by CT severity index and modified CT severity index

Objectives: To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis. Methods: Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN). Results: A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively. Conclusions: AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.

Pancreatic necrosis volume for predicting readmission and reintervention in acute necrotizing pancreatitis

PurposeTo determine the correlation between the pancreatic necrosis volume (PNV) and readmission as well as reintervention. MethodThis was a retrospective cohort study that included necrotizing pancreatitis (NP) patients who were examined with contrast-enhanced computed tomography (CT) one week before discharge. The PNV was calculated manually based on the postprocessing workstation software. Multivariate logistic regression analysis was employed to determine the independent risk factors for readmission and reintervention. ResultsA total of 167 NP patients were included. Among them, 94 (56.3%) patients were readmitted after discharge, and 55 (32.9%) patients needed further invasive intervention. The median PNV of all patients was 376.6 (interquartile range (IQR), 129.3–820.5) cm3, and the PNV was significantly higher in patients needing readmission or reintervention. Multivariate analysis showed that PNV ≥ 620 cm3 (adjusted odds ratio (adjOR), 3.08; 95% confidence interval (CI), 1.47–6.43; P = 0.003) and modified computed tomography severity index (CTSI) score ≥ 7 points (adjOR, 6.36; 95% CI, 2.05–10.70; P = 0.001) were independently associated with readmission. Stent or drainage tube placement at discharge (adjOR, 2.94; 95% CI, 1.27–6.77; P = 0.011), PNV ≥ 620 cm3 (adjOR, 5.11; 95% CI, 2.19–11.95; P < 0.001), pancreatic parenchymal necrosis (adjOR, 3.37; 95% CI, 1.42–7.96; P = 0.006), and modified CTSI score ≥ 7 points (adjOR, 4.23; 95% CI, 1.46–12.27; P = 0.008) were independent risk factors for reintervention. ConclusionsThe PNV is a useful tool for quantifying pancreatic necrosis and is strongly associated with readmission and reintervention. Additional prospective studies with larger sample sizes are needed to confirm these findings.

Procalcitonin as a predictor of severity in acute pancreatitis

Background: Outcomes and severity of acute pancreatitis is a challenging condition to diagnose. However, multiple clinico-biochemical scores, imaging, radiological imaging, and biochemical markers are used. Aims: To evaluate procalcitonin as a predictor of severity in acute pancreatitis and to correlate the levels of procalcitonin to the CT Severity Index score. Materials and Methods: In 65 study subjects, prolactin levels, CRP, blood glucose, liver function tests, BUN, creatinine, urea, CBC, and radiological investigations including whole abdomen USG, X-ray abdomen-supine and erect, and chest X-ray PA view. Following 48-72 hours of admission, a CT abdomen was done on subjects with diagnostic dilemmas. In subjects where CECT was done, necrosis scores and Balthazar grading were used for grading the CT severity index. Results: For the cut-off PCT value of 1.77 ng/ml the sensitivity, specificity, PPV, NPV, accuracy, and likelihood ratio were 74.8, 76.88, 74.8, 76.94, 74, and 15.154 respective. In the PCT cut-off value of 3.29 ng/ml, the respective values of sensitivity, specificity, PPV, NPV, accuracy, and likelihood ratio were 66.65, 84.58, 79.8, 73.31, 74, and 14.426. BCTSI score of ≥4, the respective values of sensitivity, specificity, PPV, NPV, accuracy and likelihood ratio were 62.3, 65.36, 62.3, 65.36, 65, and 3.936.