CT Severity Index Research Articles

Analysis of the Treatment Efficacy of Percutaneous Catheter Drainage Under CT Guidance for Severe Acute Necrotizing Pancreatitis

Background: Percutaneous catheter drainage (PCD) therapy is an important treatment for severe acute pancreatitis. Objectives: The purpose of this retrospective study was to analyze the relevant risk factors of computed tomography (CT) guided PCD during the treatment of infected pancreatic necrosis (IPN) in severe acute pancreatitis. Patients and Methods: This is a retrospective study. From January 2013 to November 2016, 162 patients suffering from severe acute pancreatitis with IPN were assessed using CT-guided PCD. Abdominal CT scan was performed for the patients. The interventional therapist chose the location and puncture according to the image. Depending on the efficacy and process of the treatment, these patients were divided into a PCD success treatment group and a PCD combined with surgery group. Factors affecting the success of PCD treatment were analyzed by logistic regression analysis. Results: Among the 162 cases, 71 cases (43.82%) were in the PCD success group and 91 cases (56.17%) were in the PCD combined with surgery group. Through the course of treatment, CT values of piercing zone, acute physiology and chronic health evaluation II (APACHEII) scores and modified CT severity index (MCTSI) scores showed statistically significant correlation with the therapeutic effect of PCD under CT guidance. A further multivariate analysis found that the CT value of puncture area is the best predictor for efficacy and when the CT value got higher the PCD efficacy would become lower. We performed further analysis of the factors associated with the average CT value in the puncture area which was higher than 20 Hounsfield unit (HU), and found that the length of time from patient admission to drainage, APACHEII scores, MCTSI scores and C reactive protein (CRP) levels were risk factors for PCD treatment efficacy. Conclusion: CT values of piercing zone is the major risk factor affecting the curative effect of CT guidance PCD. For patients with higher CT values in the puncture area, the longer time from patient admission to drainage, the higher APACHEII scores and MCTSI scores. Higher levels of C reactive protein seem to lower the curative effect.

Pancreatitis and hyperparathyroidism: Still a rare association!

BackgroundAmong the multitudinous etiologies of pancreatitis, primary hyperparathyroidism (PHPT) is rarely associated with pancreatitis. However, the cause and effect relationship between the two still evokes controversy. We aimed to study and characterize the nature of pancreatic disease in PHPT. MethodsA retrospective single-center study was carried out in North India over a period of 1 year (June 2015 to May 2016). All patients with pancreatitis were included. In patients with high calcium levels, Intact Parathyroid Hormone (iPTH) by Radioimmunoassay (RIA) and an Technetium 99m Sestamibi scintigraphy (MIBI-Tc-99m) scan were performed. ResultsDuring the study period, 70 patients with pancreatitis were admitted to our hospital (53 with acute pancreatitis [AP] and 17 with chronic pancreatitis [CP]). Of them, 5 patients (9.4%) were detected to have PHPT. The mean age of patients was 30.4 years (20–49 years) with 3 males and 2 females, including 1 pregnant female (29th week of gestation). Contrast enhanced computed tomography (CECT) abdomen was performed in 4 cases (excluding 1 pregnant patient) with mean Computed tomography severity index (CTSI) of 4.7 (2–8). Four patients were detected to have increased uptake in one of the parathyroid glands, and the fifth patient had an ectopic parathyroid uptake in the mediastinum. All the resected samples were identified as parathyroid adenoma on histology. The patients were followed up for 1 year with no reported recurrence of symptoms. ConclusionThe data suggest an association between pancreatitis (both acute and chronic) and hypercalcemia due to PHPT. A high calcium value during AP or CP should always draw suspicion and warrants corresponding investigations in search of endocrine or malignant cause.

Diagnosis and Staging of Acute Pancreatitis on Multidetector Computed Tomography

INTRODUCTION: Acute pancreatitis is a protean disease with varying clinical findings from mild to severe. CT is the imaging modality of choice to help stage the severity of inflammatory processes, detect pancreatic necrosis and depict local complications. Objectives of this study was to evaluate the role of MDCT in diagnosis and staging of acute pancreatitis and to identify the complications of acute pancreatitis on CT scanning. MATERIAL AND METHODS: This was a descriptive study done from 26th September 2016 to 25th March 2017. 45 patients of age range 17-85 years (29 Male and 16 Female) were included in study. CT scans were assessed for pancreatic necrosis and its complications. Computed tomography severity index (CTSI) was calculated by Balthazar’s grading + degree of necrosis points into mild, moderate and severe CTSI. RESULTS: 14 patients had mild, 14 had moderate and 17 patients had severe acute pancreatitis CTSI. Of 31 patients with pancreatic necrosis 26 (83.8%) patients showed complications and 5 (16.12%) patients were without complications. Of 14 patients without pancreatic necrosis only 5 (35.7%) patients were with complications and 9 (64%) were without complications. CONCLUSION: CT scan should be the investigation of choice if clinical diagnosis is acute pancreatitis and to assess the severity of disease to predict its course.

D Dimer as a marker of severity and prognosis in acute pancreatitis

Introduction: Acute Pancreatitis (AP) has a substantial burden on health System. AP scores needs battery of tests, applicable only after 48 hours. CT severity index (CTSI) is not helpful at an early stage. It would be of great help, with a simple single test that is widely available, cost effective which can predict Severe AP (SAP), clinical progression & outcome. Method: Prospective observational study. Diagnosis of AP and severity grading was made as per Revised Atlanta Criteria. Patients were categorised into Mild AP and Complicated AP (CAP) which includes Moderate and severe AP. D-dimer done within 3 days of disease onset. Chronic/Recurrent Pancreatitis, coagulopathy, Pregnancy, Trauma, Liver disease, on anticoagulants and organ failure excluded. Modified Marshal Scoring system used for organ failure. APACHE II score, RANSONS, CTSI used. D-Dimer, CRP, routine tests done. Mean, Median, Mann whitney U test, Chi square test, Receiver Operator Characteristic ROC curve analysis done. Result: 30 patients. 50% mild AP, 43.3% moderately severe AP, 6.7% SAP. 93.3% elevated D-Dimer. Median D-Dimer in Mild AP 567 ng/L, CAP 2732 ng/L (p<0.001). D-Dimer in normal CT 363 ng/L vs. positive CTSI 1916 ng/L (p=0.005), increases as CTSI increases (p=0.04). D-Dimer in organ failure 4776 ng/L vs 776.5ng/L in absent organ failure (p=0.001). D Dimer increases as severity of Organ failure increases (p=0.04). D-dimer in ICU patients 2732ng/L (p=0.021) D-dimer and APACHE II score correlates well with increase in predictive mortality rate (p=0.01). On ROC, D-dimer>933.5ng/L suggestive of CAP, D-Dimer > 827.5ng/L is highly associated with positive CTSI sensitivity 90.9%, specificity 83.3%, D-dimer > 1060.5ng/L suggestive of Organ failure sensitivity 85.7%, specificity 72.7%. Conclusion: Coagulopathy & microthrombi plays a significant role in early pathogenesis. D-Dimer test acts at the level of this core pathogenesis, even before the complications sets in, unlike scores/CTSI which are not helpful in the initial days of AP.

Comparison of Modified Atlanta Classification With Modified CT Severity Index in Acute Gallstone Pancreatitis

Acute Pancreatitis is one of the commonest gastro-intestinal diseases, in which patients need emergency hospitalization. It carries 10-30% mortality in severe cases. Early identification of severe cases helps in prognostication of the disease and institution of aggressive treatment. Aim To evaluate the severity of acute gall stone pancreatitis using Modified Atlanta Classification at admission and 48 hours. To compare severity of acute pancreatitis as assessed by Modified Atlanta Classification with Modified CT Severity Index (CTSI) in the second week. Materials and Methods We use Modified Marshal Score, as recommended by Revised Atlanta Classification, in our study group of 26 patients. Patients were classified into Mild, Moderate, and Severe categories at 48hrs. Contrast Enhance Computer Tomography of chest and abdomen (Gold standard) was performed at 2 weeks of presentation. Using Modified CTSI Score, patients were again categorised into Mild, Moderate, Severe cases. Results Modified Atlanta Classification correctly picked up the severe pancreatitis cases, as early as at 48hrs, with 100% sensitivity and specificity, which corresponded with CTSI at 2wks.

Serum paraoxonase (a high-density lipoprotein-associated lipophilic antioxidant) activity in clinical follow-up of patients with acute pancreatitis, with particular emphasis on oxidative stress parameters and lipid profile: a prospective pilot trial

ABSTRACTThe purpose of this study was to investigate the possible role of PON-1, an antioxidant lipophilic enzyme linked to HDL-C (high-density lipoprotein cholesterol), on the pathophysiology and clinical follow-up of acute pancreatitis. Biochemical tests, PON-1 and oxidative stress parameters (malonyl dialdehyde, MDA; superoxide dismutase, SOD; total antioxidant capacity, TAC) were evaluated in the sera of patients with acute pancreatitis at admission (day 0), day 3 and day 10 of follow-up, between June and September 2017. SPSS 13.0 statistical software package programme was used for statistical analyses.Mean age was 51.4 of the total 25 patients. Ranson scores were 0–1 points (60%), 3–4 points (24%) and 5–6 points (16%). CTSI (computed tomography severity index) scores were calculated, and most of the patients were seen to have mild or average pancreatitis (96%). While total cholesterol, triacylglycerol and LDL-C (low-density lipoprotein) levels stayed in their normal limits, there was a significant decrement tendency. HDL-C level was seen to rise significantly above its upper limit at day 10 (p < 0.001). Mean PON-1 levels were measured as 69.23, 76.72 vs. 113.15 U/mL at days 0, 3 and 10, respectively; and it was positively correlated with HDL-C (p < 0.001). Serum SOD increased also in parallel with PON-1 (20.49 vs. 39.46 U/mL) while MDA level decreased significantly (3.9 vs. 2.28 μM, p < 0.001). TAC was seen to rise significantly after treatment (0.52 vs. 1.22 mM). In conclusion, decreased PON-1 and HDL-C together with antioxidants SOD and TAC at the early period of acute pancreatitis were seen to rise after treatment, while the previously higher MDA level decreased in parallel. This reveals the importance of the balance between oxidative stress and antioxidant defense mechanisms in clinical progression of the disease, and the potential of PON-1 as a promising clinical marker.

Evaluation of the Modified CT Severity Index (MCTSI) and CT Severity Index (CTSI) in Assessing Severity And Clinical Outcomes in Acute Pancreatitis

Evaluation of the Modified CT Severity Index (MCTSI) and CT Severity Index (CTSI) in Assessing Severity And Clinical Outcomes in Acute Pancreatitis

Evaluation of the modified CT severity index (MCTSI) and CT severity index (CTSI) in assessing severity and clinical outcomes in acute pancreatitis

Evaluation of the modified CT severity index (MCTSI) and CT severity index (CTSI) in assessing severity and clinical outcomes in acute pancreatitis

A study to evaluate acute pancreatitis using modified CT severity index and correlating with clinical outcome in tertiary care hospital

A study to evaluate acute pancreatitis using modified CT severity index and correlating with clinical outcome in tertiary care hospital

Immature granulocytes: A novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis

PurposeTo investigate the relationship between immature granulocyte percentage (IG%) and acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis (AP). Materials and methodsA cohort of 2289 patients with AP was screened; 1933 were enrolled in this prospective multicenter study. Blood samples for IG% analysis were collected on admission and processed using a hematology analyzer. Demographic, radiological, and clinical laboratory data were prospectively collected and reviewed retrospectively. ResultsIncreased IG% reflected significant upward tendency of ARDS incidence and severity. Multivariable logistic regression revealed that Acute Physiology and Chronic Health Evaluation (APACHE) II, CT severity index, C-reactive protein, white blood cells, granulocytes, lymphocytes, and IG% (OR 1.297 [95% CI 1.230–1.368]) were independent factors predicting ARDS onset in patients with AP. Receiver operating characteristic curve analysis revealed that area under the curve for APACHE II and IG% were 0.837 (95% CI 0.798–0.876) and 0.821 (95% CI 0.794–0.849), respectively. The combination of APACHE II score and IG% demonstrated excellent predictive power for ARDS incidence. ConclusionsIG% is a new type of biomarker for ARDS in patients with AP, which may promote timely and efficient identification of individuals at high risk for ARDS in the early stages of disease.

Predictive value of immature granulocytes for persistent systemic inflammatory response syndrome in patients with acute pancreatitis: analysis of 1 973 cases

To analyze the clinical value of immature granulocytes in peripheral blood for prediction of persistent systemic inflammatory response syndrome (SIRS) in patients with acute pancreatitis (AP). 1 973 patients with AP in Hunan People's Hospital from 2012 to 2017 were retrospectively enrolled and divided by SIRS duration into the persistent SIRS group, temporary SIRS group and non-SIRS group. The independent risk factor for persistent SIRS in AP patients was evaluated by Logistic regression analysis, and predictive value of immature granulocytes for persistent SIRS in AP patients was analyzed by the receiver operating characteristic (ROC) curve. These 1 973 AP patients (1 165 males, 59.0%) with an average age of 49 (40, 60) years old, including 288 persistent SIRS, 189 temporary SIRS and 1 496 non-SIRS cases. There was no significant difference in gender, age and etiology among three groups. Compared with non-SIRS group, more severe symptoms were observed in the temporary and persistent SIRS groups. Moreover, The acute physiology and chronic health evaluation II (APACHE II), CT severity index (CTSI), multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS) incidence, mortality and C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT) and immature granulocytes in persistent SIRS group were further higher than those in the temporary SIRS group [APACHE II: 9 (6, 12) vs. 5 (3, 7), CTSI: 6 (4, 6) vs. 4 (3, 6), MOF incidence: 92.0% vs. 32.8%, ARDS incidence: 39.9% vs. 10.1%, morbidity: 11.1% vs. 4.2%, CRP (mg/L): 25.00 (0.80, 212.25) vs. 0.80 (0.80, 123.50), WBC (×109/L): 15.17±6.78 vs. 14.84±5.86, PCT (g/L): 0.23 (0.10, 1.76) vs. 0.10 (0.10, 0.31), immature granulocytes: 1.95 (0.90, 4.95) % vs. 0.80 (0.40, 2.10) %, all P < 0.05]. Logistic regression analysis showed that besides pancreatic necrosis, WBC and CRP, immature granulocyte was an independent risk factor for persistent SIRS associated with AP [odds ratio (OR) = 1.844, 95% confidence interval (95%CI) = 1.372-2.220]. ROC curve showed that immature granulocytes had better predictive value for persistent SIRS, the area under the curve (AUC) was 0.806, which was significantly higher than the APACHE II (AUC = 0.783), CTSI (AUC = 0.752), PCT (AUC = 0.676), CRP (AUC = 0.677), WBC (AUC = 0.644). The cut-off value of immature granulocyte was 0.65%, the sensitivity was 84.0%, the specificity was 66.3%, the positive predictive value was 62.4%, and the negative predictive value was 76.3%. Immature granulocyte in peripheral blood is a potential indicator for persistent SIRS in AP patients.

Fluid sequestration is a useful parameter in the early identification of severe disease of acute pancreatitis.

Early identification of severe disease of acute pancreatitis (AP) is of critical importance to improve the prognosis. Fluid sequestration (FS), calculated from administrated fluid and fluid output, is a simple prognostic parameter. We examined its utility in the early phase of AP. We retrospectively investigated AP patients between January 2009 and April 2017. We compared FS in the first 24h (FS24) with FS in the first 48h (FS48) and administrated fluid volume within the first 24h (FV24). Diagnostic yield for predicting intensive care unit (ICU) admission and persistent organ failure (POF) was assessed using receiver operating characteristic curves. We also evaluated risk factors for developing severe disease of AP. A total of 400 AP patients were included in the analysis (median age 64years; male 60%). According to the Japanese severity criteria, 158 patients (40%) were diagnosed as severe disease. The rates of mortality, ICU admission and POF were 0.8%, 4.5% and 7.3%, respectively. FS24 showed a similar predictive accuracy in comparison with FS48 and was superior to FV24 in predicting ICU admission and POF. FS24 ≥ 1.6L, male sex, presence of systemic inflammatory response syndrome and computed tomography severity index ≥ 3 on admission were independent risk factors for disease progression in AP in the multivariate analysis. FS24 was a simple and easily calculated parameter with high predictive accuracy for discriminating patients who needed intensive care. Patients with FS24 ≥ 1.6L had an increased risk of developing severe disease.

Assessing the CT findings and clinical course of ED patients with first-time versus recurrent acute pancreatitis

Study objectivesThe primary objective of this study was to compare Emergency Department patients with first-time versus recurrent acute pancreatitis. MethodsThis study was a retrospective chart review of patients with a diagnosis of acute pancreatitis who presented to a single academic urban emergency department from 2012 to 2016. Criteria for inclusion were clinical symptoms of pancreatitis, age greater than or equal to 18 years, ED diagnosis of acute pancreatitis, and an abdominal CT scan within 24 h of triage. Exclusion criteria were traumatic mechanism and pregnancy. Charts were reviewed by a minimum of two trained abstractors using structured data collection sheets and discrepancies were resolved by a third abstractor. Patients with first time acute pancreatitis versus recurrent acute pancreatitis were compared to determine differences in characteristics, management and disposition. Results250 patients were included in the study. Of these, 165 patients had first-time acute pancreatitis and 85 patients had recurrent acute pancreatitis. Demographics, vital signs and initial lab values were the same in both groups. Patients with recurrent acute pancreatitis were more likely to have significant findings on CT (Modified CT Severity Index, 2.09 versus 1.43, p < 0.05), more likely to require IV opiates (96% versus 75%, p < 0.001) and less likely to need ICU admission (8% versus 19%, p = 0.03). ConclusionED patients with recurrent acute pancreatitis demonstrated more significant findings on CT compared to patients with first-time acute pancreatitis but were less likely to require ICU admission.

Characterization of long-term prognosis in acute pancreatitis: An explorative analysis

Background/objectivesSeverity classification systems of acute pancreatitis (AP) assess inpatient morbidity and mortality without predicting outpatient course of AP. To provide appropriate outpatient care, determinants of long-term prognosis must also be identified. The aim of this study was to define clinical groups that carry long-term prognostic significance in AP. MethodsA retrospective study that included patients admitted with AP was conducted. Determinants of long-term prognosis were extracted: These included Revised Atlanta and Determinant Based Classification (RAC), Charlson Comorbidity Index (CCI), Modified CT Severity Index (MCTSI), etiology, and local complications (LCs). Seven surrogates of morbidity up to 1 year after discharge were also collected and subsequently imputed into a clustering algorithm. The algorithm was set to produce three categories and multinomial regression analysis was performed. Results281 patients were included. The incidences of morbidity endpoints were similar among the 3 RAC categories. Three clusters were identified that carried long-term prognostic significance. Each cluster was given a name to reflect prognosis. The limited AP had the best prognosis and included patients without LCs with a low co-morbidity burden. The brittle AP had a low co-morbidity burden and high MCTSI (LCs 94%). It ran a very morbid course but had excellent survival. The high-risk AP had the worst prognosis with the highest mortality rate (28%). They had a high co-morbidity burden without local complications. ConclusionCategories that carry long-term prognostic significance in AP have been developed. This study could help formulate appropriate follow-up and ultimately improve AP outcomes.

Acute pancreatitis in children

AimThe aim of the study was to describe the assessment and management aspects and the role of computed tomography severity index (CTSI) in children with acute pancreatitis.Materials and methodsAll the children (≤14 years) admitted to the pediatric surgery unit of our institution with acute pancreati

Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis.

AIMTo investigate the incidence and risk factors of portosplenomesenteric vein thrombosis (PSMVT) in the early stage of severe acute pancreatitis (SAP).METHODSPatients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography (CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic (ROC) curve was generated for the qualifying independent risk factors.RESULTSTwenty-five of the one hundred and forty (17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis (AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar’s CT severity index (CTSI) scores [odds ratio (OR): 2.742; 95% confidence interval (CI): 1.664-4.519; P = 0.000], hypoalbuminemia (serum albumin level < 25 g/L) (OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening (OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar’s CTSI scores was 0.777 (P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSIONHigh Balthazar’s CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.

Early predictors of hyperlipidemic acute pancreatitis.

The present study aimed to investigate early risk factors for hyperlipidemic acute pancreatitis (HLAP) in order to open up novel routes for its prevention and treatment. Demographics, laboratory data obtained within 48 h, enhanced computed tomography (CT) imaging data and the modified CT severity index (MCTSI) for 111 patients with HLAP who were assessed at Ordos Central Hospital (Ordos, China) between January 2015 and October 2017 were retrospectively analyzed. Of these, 17 patients progressed to infectious pancreatic necrosis (IPN) and 14 patients progressed to organ failure (OF), the occurrence of which were the study outcomes. The patients were divided into pairs groups: IPN and non-IPN, as well as OF and non-OF, and differences between the groups were determined regarding various clinicopathological parameters. Furthermore, univariate and multivariate regression analyses were performed to identify parameters associated with the risk of progression to IPN or OP. On univariate analysis, the following parameters were deemed as being significantly associated with the risk of IPN: Serum calcium ions, C-reactive protein (CRP), extent of necrosis, procalcitonin (PTC) and the MCTSI. Furthermore, calcium ions, red cell distribution width (RDW), extent of necrosis and the MCTSI were significantly associated with the risk of OF on univariate analysis. Multivariate logistic regression analysis for these parameters then indicated that CRP (P=0.014), RDW (P=0.025) and the extent of necrosis (P=0.022) were significant and independent predictors of progression; thus, these are early risk factors for patients with HLAP. Receiver operating characteristic curves were generated to evaluate the predictive value of these factors, and the area under the curve for the three parameters was 0.863 [95% confidence interval (CI), 0.646-0.886], 0.727 (95% CI, 0.651-0.803) and 0.833 (95% CI, 0.739-0.936), respectively. Therefore, CRP, RDW and the extent of necrosis are early predictive indexes for the risk of progression in HLAP.

Evaluation of the modified CT severity index (MCTSI) and CT severity index (CTSI) in assessing severity and clinical outcomes in acute pancreatitis

Background: The aim of our study was to compare the MCTSI, CTSI and APACHE II indices for predicting local complications and severity in acute pancreatitis (AP). Methods: Clinical data of 137 patients enrolled prospectively at our institution were analyzed. They underwent contrast-enhanced CT within the first week of symptom onset. Parameters evaluated were: local complications (pancreatic necrosis infection, need for invasive procedures against necrosis) and AP severity (persistent organ failure, admission to intensive care unit (ICU), PA severity according to the Atlanta Classification) and mortality. Chi-square and area-under-the-curve receiver-operating characteristics (AUC) were applied. Results: For local complications, the CTSI index showed little superiority over the MCTSI and APACHE II index in predicting an invasive procedure (AUC 0.824, CI: 0.71–0.94) and pancreatic necrosis infection (AUC 0.823, CI: 0.70–0.95). For AP severity prediction, the MCTSI showed superiority over CTSI and APACHE II for every single criteria evaluated: persistent organ failure (AUC 0.747, CI: 0.64–0.85) AP severity (AUC 0.758, CI: 0.65–0.87), need for ICU (AUC 0.736, CI: 0.61–0.86) and mortality (AUC 0.826, CI: 0.72–0.94). Conclusion: The MCTSI index more accurately predicts acute pancreatitis severity than CTSI and APACHE II. MTCSI is also a good local complications predictor such as need of intervention and pancreatic necrosis infection.

Risk factors of recurrent acute pancreatitis and progression to chronic pancreatitis after the first attack of acute pancreatitis

Background/aims: Estimation of recurrent acute pancreatitis (RAP) and progression to chronic pancreatitis (CP) in patients with the first attack of AP is still a huge clinical challenge. We aim to elucidate risk factors for the RAP and progression to CP. Methods: Medical records of patients with the first attack of AP between 2007 and 2016 were retrospectively reviewed. Total of 60 patients with RAP and randomly selected 120 patients with single episode AP were included. Results: On the comparison between single episode AP and RAP, younger age(42.8±11.9 vs 57.6±17.2), male(76.7 vs 56.7%), alcohol(88.3 vs 55.0%), smoking(71.7 vs 37.5%), moderately severe/severe grade of Atlanta classification(58.3 vs 32.5%), higher CT severity index(CTSI)(3.37±2.31 vs 2.62±1.89), higher Triglyceride(TG)(480 vs 245 mg/dL) were related to RAP. On the multivariate analysis, younger age(OR 0.975; 95%CI 0.953-0.997), alcohol(OR 2.817; 95%CI 2.010-6.561), CTSI(OR 1.196; 95%CI 1.063-1.345) were significant risk factors of recurrence of AP after first attack. In addition, among 60 patients with RAP, 24 patients showed CP feature and the median time to progression to CP was estimated to be 1247 days.(range 879-1614). Cox regression analysis presented that higher CTSI(OR 1.390; 95%CI 1.156-1.167), short interval to recurrence(< 1yr)(OR 2.872; 95%CI 1.193-6.914) and two or more recurrence(OR 4.198; 95%CI 1.611-10.937) were significant risk factors of progression to CP after first attack of AP. Conclusions: Younger age, higher CTSI, alcohol consumption were significantly related to RAP. Higher CTSI and short interval to recurrence, two or more recurrence were associated with progression to CP after recurrent episodes.

The Value of Modified Renal Rim Grade in Predicting Acute Kidney Injury Following Severe Acute Pancreatitis.

To retrospectively determine the value of modified renal rim grade (MRRG) in predicting acute kidney injury (AKI) in the early phase of severe acute pancreatitis (SAP). This institutional review board-approved retrospective study included patients with SAP who underwent abdominal contrast-enhanced computed tomography (CT) within 48 hours after disease onset. Modified renal rim grade, renal rim grade, CT severity index, modified CT severity index, extrapancreatic inflammation on CT scores, and posterior pararenal (PPR) space involvement were assessed. Clinical data, including bedside index of severity in acute pancreatitis and New Japanese Severity Scoring system scores, were collected. Primary end points were AKI and mortality. Scores were evaluated by receiver operating characteristic curve analysis. Correlational analyses between MRRG scores and the other scores were performed with Spearman analysis. One hundred five consecutive patients were enrolled in our study. The areas under the curve (AUCs) of MRRG in predicting AKI (0.90) and mortality (0.83) were comparable to extrapancreatic inflammation on CT (0.89 and 0.85, P > 0.05) and were higher than those of the other CT scores (P < 0.05). Modified renal rim grade score of greater than 4 yielded sensitivities and specificities of 81% and 89% for predicting AKI and 88% and 66% for mortality. Modified renal rim grade correlated moderately with bedside index of severity in acute pancreatitis (Spearman r = 0.47) and New Japanese Severity Scoring system (r = 0.43) scores. Besides, the prevalence of PPR space involvement in nonrecovery AKI patients was higher than that in recovery patients (94% vs 36%, P < 0.05). Modified renal rim grade is well correlated with the occurrence of AKI and mortality in SAP. The PPR space involvement is a promising prognostic factor for nonrecovery of AKI in SAP patients.