CT Severity Index Research Articles

HBA1C, AN OUTCOME PREDICTOR FOR PATIENTS ADMITTED IN COVID ICU TREATED WITH HAEMODIALYSIS FOR ACUTE KIDNEY INJURY

Context: COVID-19, initially identied as a respiratory illness, was soon found to cause manifestations of almost every organ system in patients of different proles. Thus, there is a need to understand possible predictors in various patient settings to improve the outcome. Aims: To study HbA1c as an outcome predictor for patients admitted in COVID ICU with acute kidney injury undergoing haemodialysis as a treatment modality. Methods and Material: From July 2020 to January 2022, data of COVID patients who underwent haemodialysis for acute kidney injury were collected. Baseline parameters and outcomes were recorded and comparison between diabetics and non-diabetics of similar COVID severity were compared. Survival analysis as per HbA1c was also performed. Results: Total 126 patients were included in this study out of which 25, 21 and 26 non-diabetics had mild, moderate and severe disease respectively, classied as per Computed Tomography Severity Index. 14, 16 and 24 diabetics had mild, moderate and severe disease respectively. The number of survivors in each severity class was signicantly higher in non-diabetics as compared to diabetics. Furthermore, in diabetics, the survival curve was signicantly better in patients with an HbA1c of 6.5-9% as compared to those with an HbA1c of >9%. Conclusions: This study reveals that intervening COVID ICU patients with haemodialysis for AKI can signicantly reduce the mortality provided they have a better pre-infection glycemic control as predicted by HbA1c levels. Also, there is a need to lower the dialysis-initiation threshold in COVID positive patients with AKI.

ASSESSMENT OF CORRELATION BETWEEN SERUM LIPASE LEVELS AND CT SEVERITY INDEX IN ACUTE AND RECURRENT PANCREATITIS CASES

Background: Acute pancreatitis is a severe inammation of the pancreas, and early assessment of its severity is crucial for proper treatment and monitoring. Diagnosis is made through clinical presentation, laboratory investigations, and imaging. Computed tomography (CT) is the primary imaging modality, and serum lipase levels are linked to the severity of pancreatitis.Aim: To assess the correlation between serum lipase levels and CT severity index (CTSI) in acute and recurrent pancreatitis cases. Methods: Case records of patients diagnosed with pancreatitis were retrospectively analyzed. The diagnosis was conrmed using biochemical markers, and severity was assessed by CTSI at admission. Results: 95 cases were analyzed, 55 were acute pancreatitis cases, and 40 were recurrent pancreatitis cases. There was no signicant correlation between serum lipase levels and CTSI in both groups. Conclusion:The study revealed that there is no signicant correlation between serum lipase levels and CTSI in acute and recurrent pancreatitis cases. This indicates that even with a mild elevation of serum lipase, the underlying pancreatitis could be severe.

A COMPARATIVE STUDY OF SERUM LIPASE, SERUM AMYLASE AND CT SEVERITY INDEX BETWEEN ACUTE AND RECURRENT PANCREATITIS

This study aimed to compare serum lipase, serum amylase, and CT severity index (CTSI) between acute and recurrent pancreatitis cases. The study was conducted retrospectively, analyzing the case records of patients diagnosed with pancreatitis in 2018 at the Government General Hospital in Guntur, India. The diagnosis of pancreatitis in all patients was established using biochemical markers, and the severity was assessed by CTSI at the time of admission. In total, 95 cases were analyzed, of which 55 were acute pancreatitis cases and 40 were recurrent pancreatitis cases. The mean age, serum lipase, serum amylase, and CTSI were compared between the two groups. Our study showed that there is no signicant difference in serum lipase and amylase values between acute and recurrent pancreatitis groups, however, the acute pancreatitis group showed a signicantly higher CT Severity Index than the recurrent pancreatitis group. So, we should be more cautious while managing acute pancreatitis patients.

Application of machine learning model based on XGBoost algorithm in early prediction of patients with acute severe pancreatitis

To establish a machine learning model based on extreme gradient boosting (XGBoost) algorithm for early prediction of severe acute pancreatitis (SAP), and explore its predictive efficiency. A retrospective cohort study was conducted. The patients with acute pancreatitis (AP) who admitted to the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University from January 1, 2020 to December 31, 2021 were enrolled. Demography information, etiology, past history, and clinical indicators and imaging data within 48 hours of admission were collected according to the medical record system and image system, and the modified CT severity index (MCTSI), Ranson score, bedside index for severity in acute pancreatitis (BISAP) and acute pancreatitis risk score (SABP) were calculated. The data sets of the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University were randomly divided into training set and validation set according to 8 : 2. Based on XGBoost algorithm, the SAP prediction model was constructed on the basis of hyperparameter adjustment by 5-fold cross validation and loss function. The data set of the Second Affiliated Hospital of Soochow University was served as independent test set. The predictive efficacy of the XGBoost model was evaluated by drawing the receiver operator characteristic curve (ROC curve), and compared it with the traditional AP related severity score; variable importance ranking diagram and Shapley additive explanation (SHAP) diagram were drawn to visually explain the model. A total of 1 183 AP patients were enrolled finally, of which 129 (10.9%) developed SAP. Among the patients from the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University, there were 786 patients in the training set and 197 in the validation set; 200 patients from the Second Affiliated Hospital of Soochow University were used as the test set. Analysis of all three datasets showed that patients who advanced to SAP exhibited pathological manifestation such as abnormal respiratory function, coagulation function, liver and kidney function, and lipid metabolism. Based on the XGBoost algorithm, an SAP prediction model was constructed, and ROC curve analysis showed that the accuracy for prediction of SAP reached 0.830, the area under the ROC curve (AUC) was 0.927, which was significantly improved compared with the traditional scoring systems including MCTSI, Ranson, BISAP and SABP, the accuracy was 0.610, 0.690, 0.763, 0.625, and the AUC was 0.689, 0.631, 0.875, and 0.770, respectively. The feature importance analysis based on the XGBoost model showed that the top ten items ranked by the importance of model features were admission pleural effusion (0.119), albumin (Alb, 0.049), triglycerides (TG, 0.036), Ca2+ (0.034), prothrombin time (PT, 0.031), systemic inflammatory response syndrome (SIRS, 0.031), C-reactive protein (CRP, 0.031), platelet count (PLT, 0.030), lactate dehydrogenase (LDH, 0.029), and alkaline phosphatase (ALP, 0.028). The above indicators were of great significance for the XGBoost model to predict SAP. The SHAP contribution analysis based on the XGBoost model showed that the risk of SAP increased significantly when patients had pleural effusion and decreased Alb. A SAP prediction scoring system was established based on the machine automatic learning XGBoost algorithm, which can predict the SAP risk of patients within 48 hours of admission with good accuracy.

RADIOLOGICAL EVALUATION AND CORRELATION OF CT CHEST WITH PROGRESS OF DISEASE IN COVID 19 PATIENTS

Introduction: 1. Corona virus disease 2019(COVID 19) is an infectious disease caused by corona virus strain known as severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Before spreading world wide, the first case was discovered in Wuhan, China in December 2019. 2. Throughout the pandemic, the role of imaging has evolved with HRCT serving as different and conceivably superior testing tool to RTPCR testing. As RTPCR will give false negative results in initial days of infection. 3. HRCT Chest aids in diagnosis, complications,detection and prognostication of COVID 19 patients. Aims And Objectives: Aim:To characterize HRCT features in patients with COVID 19 infection Objectives: 1)To investigate and quantify the severity of COVID 19 infection on HRCT. 2)To explore changes in HRCT on spectrum of duration of disease in COVID 19 patients. MaterialsandMethods:Atotalof RTPCR positive COVID 19 50patientsreferredtotheDepartmentofRadiodiagnosis,Narayana MedicalCollege and Hospital in a period from September2020 toSeptember 2021weresubjectedforthestudy.ThepatientswerestudiedusingHigh resolution CT (HRCT) sections of lung from lung apices to lung bases.Collecteddatawasanalysedfordescriptivestatistics. Results: The mean age of patients was 50 years. Therewere 31 males and 19 females in this study.Diabetes mellitus is predominant comorbidity among the patients.Moderate illness(30% 15 patients) is seen in most of the patients as per CT severity index in COVID 19 patients.On follow up CT most of the patients are moderately ill(40%) and 36% are severely ill.80% of the patients have typical CT characteristics.GGOs are the predominant CT finding in initial stage of disease while GGOs and consolidation are the predominant CT finding in later stage of disease.Most of the patients presented in early(32%) and progressive stages(38%) of disease.Most of the early stage patients progressed to progressive stage(62.5%) while few progressed to peak stage(37,5%) patients.Most of the progressive stage patients progressed to peak stage(52.6%) while few progressed to late stage(31.5%). Conclusion: The diverse COVID-19 spectrum included symptoms such as fever, coughing, shortness of breath, sore throat, etc.Positive CT findings were more noticeable in symptomatic patients and patients with co-morbid conditions, giving HRCT chest in COVID-19 patients diagnostic and prognostic significance. The CT severity index and the patients clinical symptoms have a direct correlation. CT imaging is important for monitoring patients clinical progress. The findings of this study supported the importance of chest CT in the identification and treatment of COVID-19 infection.

Early Predictors of Infected Pancreatic Necrosis in Severe Acute Pancreatitis: Implications of Neutrophil to Lymphocyte Ratio, Blood Procalcitonin Concentration, and Modified CT Severity Index

Background: Infected pancreatic necrosis (IPN) accounts for 30% mortality in severe acute pancreatitis (SAP). Early prediction of IPN occurrence is critical for prophylactic measures to be taken. This study aimed to evaluate the predicting value for IPN of combined markers at early stages of SAP. Methods: The clinical records of 324 SAP patients admitted within 48 h after disease onset were retrospectively analyzed. As potential predictors, the neutrophil to lymphocyte ratio (NLR), blood procalcitonin (PCT) concentration on the 1st, 4th, and 7th day post admission, as well as modified computerized tomography severity index (MCTSI) on the 5–7th day post admission, were extracted. Correlations between these features with IPN were analyzed using logistic regression, and predictive values were estimated using the receiver operating characteristic curve analyses. Results: NLR, PCT, body mass index, and MCTSI were significantly higher in the IPN group (p < 0.001) compared to the control, among which NLR, PCT, and MCTSI were identified as independent predictors for IPN in logistic regression model. Combination of these parameters yielded significant predicting values with an area under curve of 0.92, sensitivity of 97.2%, and specificity of 77.2% in receiver operating characteristic curve analysis. Conclusion: Combination of NLR, PCT, MCTSI might facilitate the prediction of IPN occurrence in SAP patients.

Fatty liver and acute pancreatitis severity: A prospective analysis utilizing computerized tomographic scan

Introduction: Fatty liver (FL) is often recognized in patients with acute pancreatitis (AP) and is frequently found in clinical practice because of substantial variables that put one at risk of complications. Aim: To evaluate the severity of acute pancreatitis in patients with and without fatty liver using CT severity index. Methodology: In this prospective study was carried out from June 2020 till December 2022. Liver and spleen mean attenuation values were examined using plain CT scans abdomen of patients with AP. Fatty liver was defined as a mean Hounsfield Unit (HU) liver/spleen) ratio &lt; 1. Contrast-enhanced computed tomography (CECT) scan and CT Severity Index (CTSI) to grade the severity of AP. Analyzed information in SPSS. Degree of significance was determined using the chi-square test. Results: This study comprised of 100 Patients with AP (88 (88.0%) males and 32 (32.0%) female, mean age 34.68 12.762 years), 46 (46.0%) had FL and 54 (54.0%), without FL. Patients with FL experienced much worse pancreatitis than patients without FL. Acute edematous pancreatitis (39.4% vs. 60.6%) and acute necrotic collections (58.8% vs. 41.2%) were observed in patients with FL and without FL respectively. Conclusion: The severity of acute pancreatitis is significantly influe

Predictive Risk Factors of Pancreatic Exocrine Insufficiency Developed After Acute Pancreatitis: A Retrospective Cohort Study.

The aim of this study was to compare the clinical characteristics of acute pancreatitis (AP) patients between those who developed pancreatic exocrine insufficiency (PEI) and those who did not, and to investigate the predictive factors of PEI. From October 1st 2019 to July 30th 2021, AP patients admitted at our center were included. The fecal elastase-1 assay was adopted for PEI diagnosis. The clinical characteristics, treatments, and outcomes between the patients with and without PEI were analyzed. In total, 63 males and 42 females were included. There were 27 patients with mild AP, 54 with moderately severe AP, and 24 with severe AP. The median modified computed tomography severity index (MCTSI) was 6.000(4.000, 8.000). During the follow-up, 38 patients developed PEI after AP. The univariate analysis showed that higher ASA grade (P = 0.006), more severe AP (P = 0.000), the presence of multiple organ dysfunction syndrome (P = 0.030), higher MCTSI (P = 0.000), the development of infected pancreatic necrosis (P = 0.002) and local complications (P = 0.000), higher levels of triacylglycerol (P = 0.022), video-assisted retroperitoneal debridement intervention (P = 0.015), and longer intensive care unit stay (P = 0.044) were correlated with PEI development. Furthermore, the logistic regression analyses showed that MCTSI during hospitalization is an independent risk factor for PEI development during the AP recovery period. ASA grade, severity of AP, multiple organ dysfunction syndrome, MCTSI, infected pancreatic necrosis, local complications, higher levels of triacylglycerol, video-assisted retroperitoneal debridement intervention, and longer intensive care unit stay were potentially associated with PEI development during the AP recovery period. High MCTSI was independently associated with the development of PEI during the AP recovery period, which may help alert to the possibility of PEI to help with its early detection and treatment.

Can the Computed Tomography Severity Index be a Prognostic Tool in Acute Gallstone-Induced Pancreatitis?

Can the Computed Tomography Severity Index be a Prognostic Tool in Acute Gallstone-Induced Pancreatitis?

EVALUATION AND PROGNOSTIC CORRELATION OF ACUTE PANCREATITIS USING CT SEVERITY INDEX

Background: Of all abdominal emergencies, pancreatitis is one of the most complicated and clinically difcult. The preferred imaging technique for determining the severity of acute pancreatitis and its consequences is computed tomography (CT). To evaluate the clinical outcome of acute pancreatitis and Aim: prognostic correlation based on the CT severity index. We included 30 patients with suspected acute pancr Settings and Design: eatitis attending department of Radio Diagnosis, KVG medical college and hospital during the study period (January 2022 to May 2022). All the patients were evaluated by contrast enhanced CT. The severity of pancreatitis was scored using CT severity index (Balthazar), modied severity index (Mortele) and revised Atlanta classication and the cases were classied into mild, moderate and severe. The outcome parameters studied were Length of hospital stay, Need for surgery or percutaneous intervention, incidence of infection or organ failure and death. The age group of patients was 16 Results: to 69 years with maximum patients (36%) between 25 and 35 years. Majority were males (81%). According to Modied CT Severity Index, 15% patients had mild, 42% patients had moderate and 43% had severe pancreatitis. Majority of the cases (44%) were categorized as severe pancreatitis according modied Mortele CT score. Majority of the cases were categorized as mild pancreatitis according Balthazar CTSI score and revised Atlanta classication. 38% patients are considered to have end organ failure. Hepatic failure is the most common system failure seen in 22% patients. 36% patients had evidence of systemic infection. 10% patients required surgical interventions. The score is simpler to calculate and the inter-ob Conclusions: server variability is decreased using the modied CT severity index

Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis.

Background and objectives Studies on the natural history of asymptomatic walled-off necrosis (WON) in acute pancreatitis (AP) are scarce. We conducted a prospective observational study to look for the incidence of infection in WON. Material and methods In this study, we included 30 consecutive AP patients with asymptomatic WON. Their baseline clinical, laboratory, and radiological parameters were recorded and followed up for three months. Mann Whitney U test and unpaired t-tests were used for quantitative data and chi-square and Fisher's exact tests were used for qualitative data analysis. A p-value <0.05 was considered significant. Receiver operating characteristic curve (ROC) analysis was done to identify the appropriate cutoffs for the significant variables. Results Of the 30 patients enrolled, 25 (83.3%) were males. Alcohol was the most commonetiology. Eight patients (26.6%) developed an infection on follow-up. All were managed by drainage either percutaneously (n=4, 50%) or endoscopically (n=3, 37.5%). One patient required both. No patient required surgery and there was no mortality. Median baseline C-reactive protein (CRP) was higher in infection group 76 (IQR=34.8) mg/L vs asymptomatic group, 9.5 mg/dl (IQR=13.6), p<0.001. IL-6 and tumor necrosis factor (TNF)-alpha was also higher in the infection group. The size of the largest collection (157.50±33.59 mm vs 81.95±26.22 mm, P<0.001) and CT severity index (CTSI) (9.50±0.93 vs 7.82±1.37, p<0.01) were also higher in infection group as compared to the asymptomatic group. ROC curve analysis of baseline CRP (cutoff 49.5mg/dl), size of WON (cutoff 127mm) andCTSI (cutoff of 9) showed AUROC (area under ROC) of 1, 0.97, and 0.81 respectively for the future development of infection in WON. Conclusion Around one-fourth of asymptomatic WON patients developed an infection during three-months follow-up. Most patients with infected WON can be managed conservatively.

C-reactive protein and modified computed tomography severity index in assessing severity of acute pancreatitis

Background: The mortality and morbidity associated with acute pancreatitis (AP) demands timely management and prediction of disease progression and clinical outcome. Multifactorial scoring systems shall facilitate risk stratification and prognostic assessment in AP. Aims and Objectives: The aim of the study was (i) to assess C-reactive protein (CRP) levels and modified computed tomography severity index (mCTSI) in AP patients and their association with the clinical outcome and (ii) to determine the correlation between CRP levels and mCTSI scores in AP. Materials and Methods: This cross-sectional, hospital-based study comprised 90 patients diagnosed with AP. Data collection included sociodemographic information, clinical presentation, and CRP estimation. The mCTSI score was estimated by axial slices contrast-enhanced computed tomography of abdomen and was used to assess the severity of AP. Categorical data were analyzed by Chi-square test and Pearson’s coefficient was estimated to determine the correlation between CRP levels and mCTSI score. P&lt;0.05 was adopted as level of significance. Results: The study comprised 81 males (90%) and 9 females (10%). The mean age of the patients was 36.94±9.19 years, with majority in age group of 31–40 years (40%). Alcohol consumption (&gt;50 g/day) was the commonest risk factor in 82.22% (n=74) patients, followed by hypertriglyceridemia in 13.33% (n=12) patients. Pain in abdomen was the most common presentation in 96.67% (n=87) patients, followed by vomiting 57.78% (n=52) patients. Majority of patients [82.22% (n=74)] had CRP levels of 10–21 mg/dL. Mild, moderate, and severe mCTSI scores were obtained in 17.78%, 66.67%, and 15.55% patients, respectively. There is a significant positive correlation between CRP values and mCTSI scores with r=0.3008 (P=0.003). Conclusion: CRP level had significant positive correlation with mCTSI scores in AP. Higher values of CRP and severe mCTSI scores had worse clinical outcome in AP.

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...

CORRELATION OF MODIFIED CT SEVERITY INDEX WITH CLINICAL OUTCOME IN PATIENTS OF ACUTE PANCREATITIS

Acute pancreatitis is one of the common causes of the pain abdomen. CECT plays an important role in the diagnosis and management of the disease. The modied CT Severity Index which we are using gives an idea of the inammation of the pancreas, necrosis and extra pancreatic complications. The present study is a prospective correlative study done on the patients with acute pancreatitis which is conrmed either clinically/ hematologically/ radiologically. CECT abdomen was done and the patients were categorized into mild, moderate and severe pancreatitis. The various clinical outcome parameters were taken and correlated with the severity on CECT. In our study we found that CECT is a valuable tool in diagnosing, evaluating the extent of the disease and complications and it if found correlating excellently with the clinical outcome of the patients.

Predictive value of the C-reactive protein/albumin ratio in severity and prognosis of acute pancreatitis.

To investigate the predictive value of C-reactive protein (CRP) to serum albumin (ALB) ratio in the severity and prognosis of acute pancreatitis (AP), and compare the predictive value of the CRP/ALB ratio with the Ranson score, modified computed tomography severity index (MCTSI) score, and Bedside Index of Severity in Acute Pancreatitis (BISAP) score. This cohort study retrospectively analyzed clinical data of AP patients from August 2018 to August 2020 in our hospital. Logistic regression analysis was utilized to determine the effects of CRP/ALB ratio, Ranson, MCTSI, and BISAP score on severe AP (SAP), pancreatic necrosis, organ failure, and death. The predictive values of CRP/ALB ratio, Ranson, MCTSI, and BISAP score were examined with the area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis. DeLong test was used to compare the AUCs between CRP/ALB ratio, Ranson, MCTSI, and BISAP score. Totally, 284 patients were included in this study, of which 35 AP patients (12.32%) developed SAP, 29 (10.21%) organ failure, 30 (10.56%) pancreatic necrosis and 11 (3.87%) died. The result revealed that CRP/ALB ratio on day 2 was associated with SAP [odds ratio (OR): 1.74, 95% confidence interval (CI): 1.32 to 2.29], death (OR: 1.73, 95%CI: 1.24 to 2.41), pancreatic necrosis (OR: 1.28, 95%CI: 1.08 to 1.50), and organ failure (OR: 1.43, 95%CI: 1.18 to 1.73) in AP patients. Similarly, CRP/ALB on day 3 was related to a higher risk of SAP (OR: 1.50, 95%CI: 1.24 to 1.81), death (OR: 1.8, 95%CI: 1.34 to 2.65), pancreatic necrosis (OR: 1.22, 95%CI: 1.04 to 1.42), and organ failure (OR: 1.21, 95%CI: 1.04 to 1.41). The predictive value of CRP/ALB ratio for pancreatic necrosis was lower than that of MCTSI, for organ failure was lower than that of Ranson and BISAP, and for death was higher than that of MCTSI. The CRP/ALB ratio may be a novel but promising, easily measurable, reproducible, non-invasive prognostic score that can be used to predict SAP, death, pancreatic necrosis, and organ failure in AP patients, which can be a supplement of Ranson, MCTSI, and BISAP scores.

Utility of Ranson score, computed tomography severity index, and CRP criteria in risk stratification on the day of hospital admission in patients with acute pancreatitis: A cross-sectional analysis.

The early identification of severe acute pancreatitis (AP) remains a great challenge in clinical practice and novel predictors are needed to complement available scoring systems. This study aimed to investigate utility of Ranson score, and computed tomography severity index (CTSI) and C-reactive protein (CRP) criteria in determination of risk prognostic status in AP. A total of 104 patients with AP (median age: 71.5 (range, 21-102) years, (59.6% were males) were included in this cross-sectional study. Patients were divided into two groups according to risk prognostic status including good prognosis (n=67) and poor prognosis (n=37) groups, based on presence of at least one of the poor prognostic criteria including Ranson score ≥3, presence of pseudocyst and necrotizing fluid collection on ultrasonography or computed tomography imaging and CRP levels >15 mg/L. Data on patient demographics, etiology of AP, smoking, blood biochemistry and hemogram findings and inflammatory markers including CRP (mg/L), mean platelet volume (fL), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were recorded. Overall, 37 (35.6) patients with at least one these criteria comprised the poor prognosis group. Most of patients were considered to be in the poor prognosis group based on CTSI only (35.1%), CTSI + CRP (18.9%), and CTSI + Ranson (16.2%). Overall, 6 (5.8%) patients died, and all of them were in the poor prognosis group (p=0.002). Patients with poor versus good prognosis had significantly higher median (min-max) values for creatinine (1 [0.57-10.0] vs. 0.76 [0.5-8.4] mg/dL, p=0.004) and urea (48.0 [9.0-247.0] vs. 27.0 [10.0-111.0] mg/dL, p<0.001), and lower albumin values (3.5 [2.4-4.3] vs. 3.6 [2.7-4.6] g/L, p=0.021). Kappa values indicated presence of a moderate agreement between CTSI and CRP (kappa: 0.408), a fair agreement between CTSI and Ranson (kappa: 0.312), and a none to slight agreement between Ranson and CRP (kappa: 0.175). CTSI was able to discriminate all 6 patients (100.0%) with mortality, whereas Ranson and CRP each discriminated only 2 (33.3%) of 6 patients with mortality. Our findings suggest a stronger individual prognostic value of CTSI alone, rather than CRP or Ranson score alone, in risk stratification of AP patients for severity of disease and related mortality risk on the day of admission, whereas emphasize the likelihood of using CRP or Ranson score complementary to CTSI to enable further identification of poor prognostic status.

Comparative Study of Outcomes of COVID-19 Infection in Vaccinated and Unvaccinated Patients- A Retrospective Analysis

Introduction: Vaccine development was the highest priority during the Coronavirus disease 2019 (COVID-19) pandemic. An ideal vaccine should decrease the risk of infection and reduce the incidence and severity of the disease. Risk of disease or infection following COVID-19 vaccination needs to be evaluated for its efficacy and effectiveness. Aim: To compare the severity of the disease, oxygen requirement, and mortality between vaccinated and unvaccinated COVID-19 patients. Materials and Methods: This retrospective study was done on the data of the patients who were admitted to Nizams Institute of Medical Sciences. All the admitted patients with COVID-19 disease, diagnosed by either Reverse Transcriptase Polymerase Chain Reaction (RTPCR) or rapid antigen detection method from April 2021 to October 2021, were included. Parameters recorded were: age, gender, co-morbidities, clinical staging as per institute protocol, vaccination status, oxygen requirement, the requirement of non invasive or invasive ventilation, inflammatory markers like C-Reactive Protein (CRP), ferritin, D dimer, Computed Tomography (CT) severity index, and outcomes. Results: The mean age of patients was 49.7±14.8 yrs in the unvaccinated group, and 52.75±16.2 yrs in the vaccinated group. Out of 175 patients, 102 (58.28 %) were unvaccinated. There were 25 (14.28%) deaths, of which 20 (80%) were unvaccinated and 5 (20%) were vaccinated. Oxygen requirement was more among the unvaccinated 73/96 (76.04%). High flow oxygen / mechanical ventilation requirement was higher in unvaccinated compared to vaccinated, 38 (76%) vs 12 (24%) respectively (p-value &lt;0.005). The mortality rate was higher in unvaccinated patients with co-morbidity, with an odds ratio of 3.32 (1.2-9.3), p-value=0.02. Serum ferritin levels were significantly higher in the unvaccinated group, 858.15±935.5 vs 473.4±663.2 ng/mL, p-value 0.007. CT severity index in the unvaccinated group was 13.82±5.4, and for the vaccinated group, it was 11.58±5.49. Conclusion: Severe disease, oxygen requirement, and mortality were low in vaccinated patients. Vaccination has also resulted in a statistically significant decrease in mortality in patients with co-morbidities. Serum ferritin levels were also found to be lower in vaccinated patients.

ETIOLOGY, CLINICAL PROFILE, ASSESSMENT AND COMPARISON OF SCORING SYSTEMS IN PATIENTS DIAGNOSED WITH ACUTE PANCREATITIS IN A TERTIARY CARE CENTRE

Background:Acute pancreatitis is a sudden inammation of the pancreas with an incidence 13–45 /1,00,000. A Bedside Index for Severity in Acute Pancreatitis (BISAP) has recently been proposed as an accurate and simple method for early identication of persistent organ failure and mortality. CT, as used to aid the diagnosis and staging of acute pancreatitis, has greatly improved and has changed the clinical management of this condition. 50 patients who came Methods: with acute abdomen and diagnosed with acute pancreatitis were selected satisfying inclusion and exclusion criteria. BISAP score and CT severity index was calculated and compared. Results: Out of 50 patients mild, moderate and severe acute pancreatitis was identied in 35, 9 and 6 patients respectively based on CT severity score index(CTSI). Out of 50 cases,47 had BISAP score &lt; 3 and 3 had &gt;3.BISAP score as a predictor of prognosis has a signicant relation as evident by the data in our study (p value&lt;0.05).BISAP score and CTSI are used for severity assessment of acute pancreatitis, both these scoring systems showed positive correlation in assessing the severity. Early evaluation of the Conclusion: severity of acute pancreatitis is essential to allow the clinician to predict the patient's clinical course, estimate prognosis, and determine the need for admission to the intensive care unit. BISAP score is relatively simple &amp;amp; accurate in predicting the clinical severity of Acute Pancreatitis with a prognostic accuracy of BISAP similar to CTSI.

Expression levels of RUNX3 and FGFR2 in peripheral blood of severe acute pancreatitis and their clinical significance.

Severe acute pancreatitis (SAP) is a life-threatening inflammatory syndrome of the pancreas. This study aimed to analyze the clinical significance of runt-associated transcription factor 3 (RUNX3) and fibroblast growth factor receptor 2 (FGFR2) expression alterations in SAP. This study included 18 SAP patients in Wuzhong People's Hospital from November 2019 to December 2021 and 18 healthy controls. RUNX3 and FGFR2 expression levels were determined by RT-quantitative PCR. Correlations between RUNX3/FGFR2 and sex, age, etiology, CRP, procalcitonin, AST, LDH, BUN, Acute Physiology and Chronic Health Evaluation II (APACHE II), Ranson score, Bedside Index for Severity in Acute Pancreatitis (BISAP) score, sequential organ failure assessment (SOFA), and modified computed tomography severity index (MCTSI) score were analyzed. Diagnostic values of RUNX3 and FGFR2 in SAP were analyzed using the receiver-operating characteristic curve. The binding of RUNX3 to FGFR2 was analyzed by chromatin immunoprecipitation. RUNX3 and FGFR2 were downregulated in peripheral blood of SAP patients. RUNX3 and FGFR2 were negatively correlated with CRP, procalcitonin, AST, LDH, BUN, APACHE II score, Ranson score, BISAP score, SOFA score, and MCTSI score. Sensitivity and specificity of RUNX3 level of <0.9650 for SAP diagnosis were 88.89% and 72.22%, respectively. Sensitivity and specificity of FGFR2 level of <0.8950 for SAP diagnosis were 66.67% and 83.33%, respectively. RUNX3 was enriched in the FGFR2 promoter and was positively correlated with FGFR2. RUNX3 and FGFR2 were downregulated in peripheral blood of SAP patients and served as candidate biomarkers for SAP diagnosis. RUNX3 bound to the FGFR2 promoter to promote FGFR2 transcription.

Modified computed tomography severity index in evaluation of acute pancreatitis and its correlation with clinical outcome: A prospective observational study from a tertiary care teaching hospital, India.

Acute pancreatitis (AP) is one of the most common yet, the most complex and challenging abdominal emergencies encountered by clinicians globally. It runs an unpredictable course. One-fifth of all AP patients develop complications. Many prognostic predictive scoring systems are used for AP. The aim of our study was to evaluate the usefulness of modified computed tomography severity index (MCTSI) scores to predict the need for intensive care unit (ICU) stay, complications, and mortality in patients of AP. An observational, prospective study was conducted for 1 year. Fifty cases diagnosed as AP were included in this study. Contrast-enhanced computed tomography of the abdomen and pelvis was carried out in all patients. MCTSI was calculated according to CT findings. Patients' demographic details, clinical findings, duration of hospital stay, complications, and interventions were recorded. SPSS version 26.0 was used for statistical analysis. A. Grading by modified CT severity index has a significant direct correlation with the necessity of ICU admission, duration of ICU stay, and total duration of hospital stay. A modified CT severity index can be used to predict the possibility of developing local and systemic complications as well as the need for interventions. Modified CTSI is a reliable predictor of clinical course and outcome in cases of acute pancreatitis.