CT Severity Index Research Articles

Intra-abdominal infection in acute pancreatitis in eastern China: microbiological features and a prediction model.

BackgroundThis study aimed to investigate the microbiol distribution of intra-abdominal infection in patients with acute pancreatitis, and to develop a reliable prediction model to guide the use of antibiotics.MethodsInpatient with acute pancreatitis between January 2015 and June 2020 were enrolled in the study. Participants were divided into the intra-abdominal infection group and non-infection group. Isolated pathogens and antibiotic susceptibility were documented. Characteristics parameters, laboratory results, and outcomes were also compared. Least absolute shrinkage and selection operator (LASSO) regression model was used to select the risk factors associated with intra-abdominal infection in patients with acute pancreatitis. Logistic regression analysis, random forest model, and artificial neural network were also used to validate the performance of the selected predictors in intra-abdominal infection prediction. A novel nomogram based on selected predictors was established to provide individualized risk of developing intra-abdominal infection in patients with acute pancreatitis.ResultsA total amount of 711 participants were enrolled in the study, and of these, 182 (25.6%) had intra-abdominal infection. Of the 247 isolated pathogens, 45 (18.2%) were multidrug-resistant bacteria, and antibiotic susceptibility was lower than that of China Antimicrobial Surveillance Network 2020. The LASSO method identified 5 independent predictors [intra-abdominal pressure (IAP), acute physiology and chronic health evaluation II (APACHE II), computed tomography severity index (CTSI), the severity of pancreatitis, and intensive care unit (ICU) admission] of intra-abdominal infection, which were validated by three different models. The area under the curve was >0.95 for all 5 predictors. A clinically useful nomogram based on these predictors was successfully established.ConclusionsMultidrug-resistant bacteria were quite common in intra-abdominal infection. IAP, APACHE II, CTSI, the severity of pancreatitis, and ICU admission were identified as risk factors and the new nomogram based on these could help clinicians estimate the risk of intra-abdominal infection and optimize antimicrobial prescription for acute pancreatitis patients.

Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention.

Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP. This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson's score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups. A total of 100 patients with AP were treated during out study period. Ranson's score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p <0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p <0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson's score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p <0.05). We validate SIRS, Ranson's, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.

SERUM D-DIMER AS A TOOL FOR ASSESSMENT OF SEVERITY IN PATIENTS OF ACUTE PANCREATITIS

Introduction: Acute Pancreatitis (AP) is a potentially life threatening disease with varying severity of presentation from mild pain to persistent organ failure. D-dimer is an indirect measure of brin degradation products. It is a stable molecule with half-life of 4-8 hours. Material &amp;Method: This is a prospective study done on 60 patients of acute pancreatitis treated at Department of General Surgery, Sir Sunderlal Hospital IMS BHU Varanasi, UPfrom the period of 2016 to 2018. Patients with diagnosis of APas per revised Atlanta classication were taken and D-dimer level was assessed at the time of presentation and patients were followed to assess the severity of disease and outcome. The D-dimer values were correlated with the Glasgow-Imrie score as well as the CTseverity index (CTSI) Result: Median value of D-dimer was found to be 3.68 mg/IFEU among the cases and 0.3 mg/IFEU among healthy volunteers. D-dimer levels increased as per CTSI severity score ranging from 2.97 to &gt;5.70 mg/IFEU along with increased mortality in patients whom D-dimer levels were found to be high. D-dimer also showed positive correlation with Glasgow–Imrie score. Conclusion: Determining the serum concentration of D-dimer on day of admission is helpful in earlier prediction and assessment of severity of AP.

Computed tomography severity index and serum CRP concentration for predicting the severity of acute pancreatitis

Background: The assessment of the severity of pancreatitis is important for management of this challenging disease. An accurate system which could predict the severity and identify the local extent and complications of a serious inflammation is beneficial for the patient outcome. The aim was to establish the value of the CTSI in predicting the severity of acute pancreatitis and to compare it with the accuracy of the serum CRP concentrations.Methods: Prospective clinical study based on analysis of 55 patients. Each patient underwent thorough clinical and biochemical analysis and CECT abdomen. CTSI within 5 days, serum CRP level 48 hours after admission.Results: The mean values of predictive markers in the mild and the severe pancreatitis groups were: computed tomography severity index 1.26 and 6.30 (p&lt;0.001) and CRP 96.0 mg/l and 192.4 mg/l (p&lt;0.001), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for the CTSI (greater than 3: 85%, 98%, 92%, 95%, and 95%) and for CRP (equal to, or greater than 150 mg/l: 85%, 74%, 50%, 94%, and 76%).Conclusions: We found a close correlation with CRP levels and the CTSI of patients having severe pancreatitis and a CTSI score greater than 3 had a serum CRP level in excess of 150 mg/l. CRP is incapable of identifying local complications. The CTSI is a reliable method for staging the severity of acute pancreatitis and showing the local extent of the inflammation and the occurrence of local complications.

Clinical and radiological parameters among COVID deaths in a tertiary care COVID hospital

Background: A total of 10682 patients were admitted in our tertiary care COVID hospital from April 2020 to January 2021. 419 patients died with a mortality rate of 3.92%. We have analysed 241 deaths that have taken place till 10th September 2020. Methodology: We studied the history, symptomatology, HRCT chest, comorbidities, duration of hospital stay and special drugs administered along with the type of oxygen therapy. Results: 88% of patients have more than 30% lung burden by HRCT. All the patients have a CO-RADS score of 4 or more. 81% of the patients have CT severity index of 15/25 or more. The CO-RADS classification is a standardized reporting system for patients with suspected COVID-19 infection developed for a moderate to high prevalence setting. 71% of patients expired within first five days of admission. 23% of patients died in 5 to 10 days of admission. 80% of patients presenting with < 80> Conclusions: Patients dying of COVID-19 disease had significant CT scan changes suggestive of corona disease. Past history of lung disease was seen in only a third. Shortness of breath was the commonest symptom and majority of the patients presented with SPO2 of Keywords: COVID 19, Corona, CORADS Score, Lung burden, CT severity Index, Happy hypoxia, MMRC scale.

The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis

BackgroundHypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers.MethodsLaboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP.ResultsSeventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (all P < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L, P = 0.004, OR = 3.362, 95%CI = 1.492–8.823) and apolipoprotein A-I (< 1.1 g/L, P < 0.001, OR = 5.126, 95%CI = 2.348–11.195), as well as high C-reactive protein (> 90 mg/L, P = 0.005, OR = 3.061, 95%CI = 1.407–6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070–4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (all P < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (all P < 0.05).ConclusionsLow serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.

Correlation of Modified Computed Tomography Severity Index with Biochemical Markers in Acute Pancreatitis

Introduction Multislice computed tomography examinations performed 3 to 4 days after the onset of symptoms is the imaging procedure of choice in acute pancreatitis, which is mainly done for evaluating the complications. Due to radiation exposure and cost, alternative scoring systems like Ranson’s score and Glasgow’s score were devised but were cumbersome. The serum amylase and lipase were found to increase with progression of disease. The objective of this study was to evaluate the association of acute pancreatitis by modified CT scoring system with the serum levels of amylase and lipase. Material and Methods In hundred patients presenting with acute pancreatitis, the severity of pancreatitis was recorded using the modified CT severity index. The serum amylase and lipase levels were recorded and correlated with modified CT severity index score. Results Among 100 patients studied, 46%, 40% and 14% had mild, moderate and severe grades of pancreatitis respectively by modified CTSI score. No significant correlation was found between the levels of serum amylase (r = -0.104, p = 0.301) and lipase (r = -0.177, p = 0.079) with the modified CT severity index in patients with acute pancreatitis. Conclusion The serum level of amylase and lipase had non-significant correlation with the modified CT severity index score and thus did not indicate severity of pancreatitis.

Spectrum of CT appearance and CT severity index of COVID-19 pulmonary infection in correlation with age, sex, and PCR test: an Iraqi experience

BackgroundSince June 2020, an explosion in number of new COVID-19 patients has been reported in Iraq with a steady increment in new daily reported cases over the next 3 months. The limited number of PCR kits in the country and the increment in the number of new COVID-19 cases makes the role of CT scan examinations rising and becoming essential in aiding the health institutions in diagnosing and isolating infected patients and those in close contacts. This study will review the spectrum of CT pulmonary changes due to COVID-19 infection and estimate the CT severity score index and its relation to age, sex, and PCR test results.ResultsThe ground glass opacities were the most common encountered pattern of pulmonary changes and were seen in (79%). There was strong positive correlation between higher CT severity score and male gender (p value = 0.0002, R2 = 0.9). Also, there was significant correlation of CT severity score and increasing age (p value less than 0.00018). Significant correlation was seen between CT scan percentage of lung involvement and positive PCR test results (p value = 0.001917), as the CT severity index is increasing, the PCR test is more likely to be positive.ConclusionsChest CT is an important and fast imaging tool for the diagnosis of COVID-19-infected patients especially in developing countries. In addition, chest CT can predict the disease severity by showing the percentage of lung involvement and hence give an idea about the prognosis of the disease. Higher CT severity score is significantly correlated with male gender, older age group patients and likely positive PCR test.

Necrotizing Pancreatitis from Hypertriglyceridemia: More Severe Disease?

Necrotizing pancreatitis (NP) is caused by hypertriglyceridemia (HTG) in up to 10% of patients. Clinical experience suggests that HTG-NP is associated with increased clinical severity; objective evidence is limited and has not been specifically studied in NP. The aim of this study was to critically evaluate outcomes in HTG-NP. We hypothesized that patients with HTG-NP had significantly increased severity, morbidity, and mortality compared to patients with NP from other etiologies. A case-control study of all NP patients treated at a single institution between 2005 and 2018 was performed. Diagnostic criteria of HTG-NP included a serum triglyceride level > 1000mg/dL and the absence of another specific pancreatitis etiology. To control for differences in age, sex, and comorbidities, non-HTG and HTG patients were matched at a 4:1 ratio using propensity scores. Outcomes were compared between non-HTG and HTG patients. A total of 676 NP patients were treated during the study period. The incidence of HTG-NP was 5.8% (n = 39). The mean peak triglyceride level at diagnosis was 2923mg/dL (SEM, 417mg/dL). After propensity matching, no differences were found between non-HTG and HTG patients in CT severity index, degree of glandular necrosis, organ failure, infected necrosis, necrosis intervention, index admission LOS, readmission, total hospital LOS, or disease duration (P = NS). Mortality was similar in non-HTG-NP (7.1%) and HTG-NP (7.7%), P = 1.0. In this large, single-institution series, necrotizing pancreatitis caused by hypertriglyceridemia had similar disease severity, morbidity, and mortality as necrotizing pancreatitis caused by other etiologies.

Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis.

BackgroundRenal dysfunction is a leading cause of death in patients with acute pancreatitis (AP) and often occurs later than respiratory complications. Whether respiratory complications can predict renal impairment remains unclear. The aim of this study was to investigate the association between pleural effusion and renal dysfunction in AP.Material/MethodsMedical records were reviewed from individuals who were hospitalized with AP from January 1, 2015 to December 31, 2019. The patients were divided into 2 groups, based on the presence or absence of pleural effusion on admission. Disease severity, renal function parameters, and outcomes were compared between the 2 groups.ResultsA total of 222 patients were enrolled, 25 of whom had pleural effusion on admission and 197 who did not. Patients with AP who had pleural effusion had more serious illness (higher incidences of pancreatic inflammation, pancreatic fluid collection, and moderate-to-severe AP; worse Bedside Index for Severity in Acute Pancreatitis score; and a higher modified computed tomography severity index [all P<0.05]) plus worse outcomes (higher incidences of ventilation and vasopressor use [both P<0.05]). Moreover, patients with pleural effusion had a higher level of blood urea nitrogen and lower estimated glomerular filtration rate (both P<0.05). After adjustment for potential confounders, pleural effusion was a risk factor for renal failure in patients with AP (odds ratio 6.32, 95% confidence interval 1.08–36.78, P=0.040).ConclusionsPleural effusion is associated with severe renal dysfunction in AP. Therefore, efforts should be made to improve early recognition and timely treatment of renal failure by closely monitoring renal function in patients with AP and pleural effusion on admission.

CT severity indices derived from low monoenergetic images at dual-energy CT may improve prediction of outcome in acute pancreatitis

To determine whether imaging features and severity indices using low monoenergetic DECT images improve diagnostic conspicuity and outcome prediction in acute pancreatitis compared to conventional images. A retrospective study of patients with clinical and radiographic signs of acute pancreatitis who underwent 50 contrast-enhanced CT exams conducted on a single-source DECT was performed. Representative conventional and 50 keV-monoenergetic images were randomized and presented to four abdominal radiologists to determine preferred imaging for detecting fat stranding and parenchymal inflammation. Contrast and signal-to-noise ratios were constructed for necrotic, hypoattenuated, inflamed, and healthy parenchyma. These parameters and the CT severity index (CTSI) were compared between conventional and low monoenergetic images using paired t tests and correlated to clinical outcome. Although preference for conventional images was noted for subtle peri-pancreatic fat stranding (169/200 (85%) reads), there was clear preference for low monoenergetic images among all readers for pancreatic inflammation evaluation (188/200 (94%) reads). Moreover, identification of small, hypoattenuating inflammatory foci on monoenergetic images alone in 13/50 (26%) cases resulted in upstaged CTSI from mild to moderate in 7/50 (14%), associated with longer hospitalization (16 ± 17 days vs. 5 ± 2 days; p < 0.05), ICU admission, and drainage. Quantitatively, a twofold difference between normal and inflamed parenchyma attenuation was identified for monoenergetic (44.8 ± 27.6) vs. conventional (25.1 ± 14.7) images (p < 0.05). Significant increases were seen in the monoenergetic SNR and CNR compared to the conventional images (p < 0.05). DECT low monoenergetic images afford better tissue assessment and demarcation of inflamed pancreatic parenchyma. Additionally, they provide improved characterization of the extent parenchymal necrosis, enabling better classification that may better predict severe clinical outcomes. • DECT low monoenergetic images afford better tissue assessment and demarcation of inflamed pancreatic parenchyma and provide improved characterization of the extent parenchymal necrosis. • Qualitatively, low monoenergetic images were preferred over conventional DECT images for the evaluation of pancreatic inflammation; and quantitatively, there is a twofold difference between normal and inflamed parenchyma attenuation, SNR, and CNR between monoenergetic vs. conventional images. • Monoenergetic imaging identified additional small, hypoattenuating inflammatory foci in 26% resulting in an upstaged CT severity index in 14% associated with longer hospitalization, ICU admission, and drainage, thereby enabling better classification and better prediction of severe clinical outcomes.

Comparison of different risk stratification systems for prediction of acute pancreatitis severity in patients referred to the emergency department of a tertiary care hospital.

Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP. We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves. mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]). mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.

Correlation of Modified Computed Tomography Severity Index with Ranson’s Criteria in Assessing Severity of Acute Pancreatitis

Introduction: Acute Pancreatitis (AP) is an illness which results in increase in morbidity and mortality when there is a delay in diagnosis and there are false results. Various scales help in making early and accurate diagnosis of AP and predict prognosis. Validity of these scales needs to be studied and compared. Balthazar score and Ranson’s criteria have been commonly used. Modified CT score’s usefulness need to be studied as it involves only CT and their early detection will help in reducing the morbidity (reducing the residual damage) and mortality. Aim: To determine validity of modified Computed Tomography Severity Index (CTSI) and Ranson’s score in assessing severity of AP and study their correlation. Materials and Methods: This is an observational study among 39 patients with AP. Ranson’s score and Modified CT index was calculated and actual outcome of the disease was observed. results: Ranson’s Score and Modified CTSI were strongly correlated with rho value of 0.912 and p-value of &lt;0.001. Sensitivity and specificity of Ranson’s criteria in predicting the actual outcome of the disease is 80% and 83.3%, respectively. Sensitivity and specificity of Modified CT criteria in predicting the actual outcome of the disease is 93.33% and 54.17%, respectively. conclusion: From the results of this study, it is evident that Modified CT index is more sensitive than Ranson’s score, but less specific.

SEVERITY ASSESSMENT OF ACUTE PANCREATITIS USING SEVERITY INDICES, REVISED ATLANTA CLASSIFICATION AND CORRELATING WITH CLINICAL OUTCOMES

To determine the prognostic efficacy of CT severity index, Modified CT severity index and Revised Atlanta Classification in acute pancreatitis. Materials and method: This prospective study was carried out from February 2019 to June 2020 on 42 patients who were referred to the Dept. of Radiodiagnosis, GMCH with acute pancreatitis and underwent the contrast enhanced CT after 72 hours of onset of symptoms. The severity of pancreatitis was assessed and scored using CTSI, MCTSI and RAC. Clinical outcome parameters included duration of hospital stay and ICU, presence of persistent organ failure (OF), evidence of infection, need for intervention, and mortality. Results: Out of 42 cases, 33 were males, age group 20-85 years (mean 47.69 ± 16.32). As per CTSI 61.9% had mild, 35.7% moderate and 2.4% severe pancreatitis. Based on MCTSI grading, 21.4% had mild, 59.6% moderate and 19% severe pancreatitis. Based on RAC grading, 31% had mild, 52.4% moderate and 16.6% severe pancreatitis. Area under the curve were generated using ROC analysis. Duration of stay of the patients, presence of organ failure and the evidence of infection was significantly associated with CTSI, MCTSI and RAC (P &lt; 0.001). Need for intervention was significantly associated with only MCTSI. Conclusion: ROC analysis of the three scoring systems for the prediction of various patient outcomes in our study revealed that the AUCs overlap, showing all the three scoring systems performed well. Duration of stay of the patients, presence of organ failure and the evidence of infection was significantly associated with CTSI, MCTSI and RAC (P &lt; 0.001). Need for intervention was significantly associated with only MCTSI.

Serial Estimation of Serum Myeloperoxidase in Patients of Acute Pancreatitis: A Pilot Study

Introduction: Acute Pancreatitis (AP) is an inflammatory condition having varied presentation ranging from a mild self-limiting illness to a severe disease with multi organ failure. Excessive recruitment of leukocytosis is an important pathophysiological feature and Myelo-Peroxidase (MPO) forms an important part of neutrophil induced inflammation. The current prognostic criteria are complex and cumbersome. Materials and methods: The present cross sectional pilot study serial estimation of plasma MPO levels were done at the time of admission and on 3, 7 and 14 days in patient of Acute Pancreatitis (n=64) patient with acute abdominal symptoms (n=15) otherthan acute pancreatitidand healthy volunteers (n=15). The values of serum MPO levels were correlated with Ransons`s score, Apache score, CT severity index and patient developing local and systemic complications due to acute pancreatitis. Serum MPO levels in (mU/ml) were measured by colorimetric Assay kit (bio Vision, USA). Statistical Analysis on SPSS (Windows version 21.0) Results: The mean serum MPO levels were significantly high in patients of AP as compared to controls comprising of patients with acute for to abdominal conditions and healthy individuals (mean 12.73 vs. 1.67 mU/ml. p<0.001). The highest levels of serum MPO were observed on the first day of mild and severe AP. The mean MPO levels in mild diseases (n=21 patients) were 3-10 mU/ml and 10-20 mU/ml in severe AP (n=43 patients) who also experienced higher local complications and worse outcome in terms of mortality. MPO returned to normal levels within 7-10days in mild but were persistently raised in patients with severe diseases. Conclusion: The higher serum MPO levels correlated with more severe diseases, worse outcome and can be a simple and effective prognostic indicator in AP.

Comparative Study of CT Severity Index and Outcome in Hospitalised Vaccinated and Non Vaccinated Patients of Covid 19 Pneumonia

SARS-CoV-2 virus typically causes lung infiltration causing acute respiratory distress syndrome (ARDS) and in later stages pulmonary fibrosis. Vaccines provide immunity against desired pathogen. Vaccines available in India against this virus are Covishield and Covaxin (majority of the patients are vaccinated with Covishield). COVID-19 causes lung parenchymal infiltration which leads to pneumonitis. The best modality available to study this is the HRCT. Analysis of the extent of lung parenchyma invasion of patients despite taking one or both the doses was done by us. For which , we did a single centered retrospective observational study in laboratory confirmed COVID-19 positive patients with sample size (n=274) being duration dependent (2 months). We found a statistically significant correlation between vaccination status and lung involvement based on HRCT Thorax. In conclusion the presence of vaccination reduces the severity of the CT severity score and improves the outcome in terms of survival of the patient.

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

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

Evaluation of the modified computed tomography severity index (MCTSI) and computed tomography severity index (CTSI) in predicting severity and clinical outcomes in acute pancreatitis.

Our main purpose was to compare the modified computed tomography severity index (MCTSI), computed tomography severity index (CTSI), and acute physiological and chronic health evaluation (APACHE)-II predictions regarding severity according to the revised Atlanta classification 2012 and local complications in acute pancreatitis in a consecutive prospective cohort. One hundred and forty-nine patients diagnosed with acute pancreatitis were prospectively enrolled. APACHE-II, MCTSI, and CTSI were calculated for all cases. Severity parameters included persistent organ or multiorgan failure, length of hospitalization, the need for intensive care, death, and local complications (intervention against necrosis and infected necrosis). Area under the receiver operating characteristic curve (AUROC) was calculated and the value of scoring systems was compared. Both CTSI and MCTSI were associated significantly with all the evaluated severity parameters and showed a correlation between imaging severity and the worst clinical outcomes. Persistent organ failure, persistent multiorgan failure, and death were found in 30 (20.1%), 20 (13.4%), and 13 (8.7%) patients, respectively. The most common extrapancreatic finding was pleural effusion in 76 (51.0%) patients. The AUROC for CTSI was higher for predicting persistent organ failure (0.749, 95% confidence interval [CI] 0.640-0.857), death (AUROC 0.793, 95% CI 0.650-0.936), intervention against necrosis (AUROC 0.862, 95% CI 0.779-0.945), and infected necrosis (AUROC 0.883, 95% CI 0.882-0.930). CT indexes outperformed the classic APACHE-II score for evaluating severity parameters in acute pancreatitis, with a slight advantage of CTSI over MCTSI. CTSI accurately predicted pancreatic infections and the need for intervention.

Analysis of associations of FBXL19-AS1 with occurrence, development and prognosis of acute pancreatitis.

The aim of the study was to explore the association between F-box and leucine-rich repeat protein 19-antisense ribonucleic acid 1 (FBXL19-AS1) and acute pancreatitis (AP) and its role in prognostic evaluation. According to the severity of AP, the patients were classified into mild group, moderate-severe group, and severe group, and the expression of FBXL19-AS1 was compared among the three groups. The associations of FBXL19-AS1 with Atlanta classification, computed tomography severity index (CTSI), acute physiology and chronic health evaluation (APACHE) II score, bedside index for severity in acute pancreatitis (BISAP) and Ranson score were analyzed. The optimal cut-off point of severe hyperlipidemia-induced AP was predicted by the receiver operating characteristic (ROC) curves. Then, the incidence rates of local and systemic complications were compared among AP patients with different levels of FBXL19-AS1. After overexpression of FBXL19-AS1 in AP cells, the quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) results showed that significantly upregulated the mRNA level of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and IL-6. The opposite results were obtained after the knockdown of FBXL19-AS1 in cells. There were no statistical differences in the basic data among the three groups. The FBXL19-AS1 level was increased in severe group than the moderate-severe group and mild group. The area under the curve (AUC) of FBXL19-AS1 in predicting severe AP was 0.9177 (p<0.001). According to the Spearman correlation analysis, the FBXL19-AS1 level had significant positive correlations with the predictive scores of AP severity. The incidence rate of shock, liver dysfunction, and pancreatic necrotic tissue infection was significantly higher in FBXL19-AS1 high-expression group than that in FBXL19-AS1 low-expression group. FBXL19-AS1 could promote the upregulation of inflammatory indexes. FBXL19-AS1 is highly expressed in the serum of AP patients, and it is positively correlated with the severity of AP. FBXL19-AS1 mediates the inflammatory response and promotes the occurrence and development of pancreatitis, harming the prognosis of patients.

Study of parameters associated with severity of acute pancreatitis

Background: Acute pancreatitis is a condition associated with a lot of morbidity. There are several scoring systems that predict the severity of acute pancreatitis, but none are perfect. The aim of this study is to study the various predictors of severity know the association of the parameters with severity of disease.Methods: Our study is a prospective observational study conducted on 80 consecutive patients who presented with features of acute pancreatitis between 20-80 years age group, attending the department of General Surgery, Sree Gokulam Medical College and research foundation, Venjaramoodu, Trivandrum during the period of November 2012 to May 2014. The obtained data was uploaded in Microsoft excel sheet and analysed. Finally, all these variables were correlated with the severity of the disease to find out the association and significance using appropriate statistical methods like Pearson Chi-square test, ANOVA and Kruskal Wallis test.Results: In our study 59 (74%) were males and mean age was 45.78. Pulse rate, total count C-reactive protein, serum amylase, lipase, Low density lipoprotein (LDH), pH, calcium, lowering of haematocrit, Computerized tomography severity index (CTSI) and Ranson’s score had significant association with severity of pancreatitis.Conclusions: One should not wait for any single scoring system to get scored for effective treatment. A diagnosis of pancreatitis should be made using clinical, laboratory and radiological means and treatment in the form of aggressive crystalloid resuscitation should be started with intensive care monitoring at the earliest.