Modified CT Severity Index Research Articles

A simple new scoring system for predicting the mortality of severe acute pancreatitis: A retrospective clinical study.

It is critical to accurately identify patients with severe acute pancreatitis (SAP) in a timely manner. This study aimed to develop a new simplified AP scoring system based on data from Chinese population.We retrospectively analyzed a consecutive series of 585 patients diagnosed with SAP at the Changhai hospital between 2009 and 2017. The new Chinese simple scoring system (CSSS) was derived using logistic regression analysis and was validated in comparison to 4 existing systems using receiver operating characteristic curves.Six variables were selected for incorporation into CSSS, including serum creatinine, blood glucose, lactate dehydrogenase, heart rate, C-reactive protein, and extent of pancreatic necrosis. The new CSSS yields a maximum total score of 9 points. The cut-offs for predicting mortality and severity (discriminating moderately SAP from SAP) were set as 6 points and 4 points respectively. Compared with 4 existing scoring systems, the area under the receiver operating characteristic of CSSS for prediction of mortality was 0.838, similar to acute physiology and chronic health evaluation II (0.844) and higher than Ranson's score (0.702, P < .001), bedside index of severity in acute pancreatitis (0.615), and modified computed tomography severity index (MCTSI) (0.736). For predicting SAP severity, CSSS was the most accurate (0.834), followed by acute physiology and chronic health evaluation II (0.800), Ranson's score (0.702), MCTSI (0.660), and bedside index of severity in acute pancreatitis (0.570). Further, the accuracy of predicting pancreatic infection with CSSS was the highest (0.634), similar to that of MCTSI (0.641).A new prognostic scoring system for SAP was derived and validated in a Chinese sample. This scoring system is a simple and accurate method for prediction of mortality.

Correlation between modified CT severity index and retroperitoneal extension using the interfascial planes in the grading of clinically suspected acute severe pancreatitis

BackgroundThis prospective study was conducted between January 2015 and June 2018 and included 50 patients (mean age of 52.12 ± 2.0 years), all presented with acute pancreatitis and admitted to the ICU 1–3 days after the onset. All patients underwent contrast-enhanced CT, and images are evaluated by 2 independent radiologists for the modified CTSI parameters and retroperitoneal extension parameters to detect the severity of pancreatitis. The aim of this study is to compare the results of the modified CT severity index and retroperitoneal interfascial extension CT grading system in the grading of the severity of acute pancreatitis and compare both grading systems to the clinical course of the disease and its complications.ResultsBoth grading systems show a statistical significant correlation in terms of the length of hospital stay, the need for interventions, and the development of organ failure.ConclusionIn conclusion, a good correlation was observed between the modified CTSI and retroperitoneal extension grading systems in grading the severity of acute pancreatitis. We think that we can apply Ishikawa et al. grading system as a prognostic indicator if there is a contraindication to contrast administration.

Radiation dose from computed tomography in patients with acute pancreatitis: an audit from a tertiary care referral hospital.

There is a limited data on the radiation dose from computed tomography (CT) in patients with acute pancreatitis (AP). The present study evaluated the radiation dose from CT scans in patients with AP. A retrospective review of CT reports of patients with AP was conducted. The type of CT scan (non-contrast vs. single-phase vs. biphasic CT) was recorded. The mean number of CT scans and cumulative radiation dose was calculated. The indications and abnormalities on biphasic CT scans were recorded. The radiation doses between different types of the scan were compared. 495 CT studies in 351 patients were evaluated. In patients (n = 78, 22.2%) undergoing multiple CT scans, mean number of CT scans per patient and mean radiation dose were 2.64 ± 1.18 (range 2-9) and 24 ± 15mSv (range 8.3-79.8mSv), respectively. The mean radiation dose was significantly greater in patients with modified CT severity index ≥ 8 (n = 63) [25.08mSv vs. 18.96mSv, (P = 0.048)]. 61 (12.32%) biphasic scans were performed. A definite indication for a biphasic CT scan was identified in 20 (32.7%) patients. Arterial abnormalities were detected in 6 (9.8%) patients undergoing CT for defined indication. Mean radiation dose in this group was 13.26 ± 7.64mSv (range 3.42-38.27mSv) which was significantly greater than the single venous phase scan (7.96 ± 3.48mSv, P < 0.001). There is a potential for substantial radiation exposure from CT scans to patients with AP. Patients with severe AP and those undergoing biphasic scans have significantly higher radiation exposure. Hence, routine arterial phase acquisition should be avoided.

A study on significance of computed tomographic evaluation of acute pancreatitis: A prospective observational study

Background: Acute pancreatitis is a common disease with high rate of morbidity and mortality. Computed tomography is the gold standard technique not only for its global picture of the pathology and for the non-invasive method of evaluating the morphology of pancreas and peripancreatic regions in an acute situation. Aim & Objectives: The purpose of the study was to determine the value of computed tomography evaluation in early diagnosis of severity, differences between pancreatitis & acute pancreatitis caused by mass lesions.Methodology: A prospective study comprise of 60 patients on clinical suspicion/diagnosis of acute pancreatitis, altered biochemical parameters (serum amylase, serum lipase) in favor of acute pancreatitis, Ultrasonography suggestive of acute pancreatitis and known case of chronic pancreatitis with features of acute symptoms referred to Department of Radio-diagnosis, Medical College and Research Hospital for computed tomography scan of abdomen and pelvis using Toshiba Asteion spiral Computed Tomography scan. Plain and post-contrast series of the abdomen and pelvis were taken.Results: In this prospective study of 50 patients, 40 were male and 10 were female patients. Among these edematous pancreatitis was in 20% patients and pancreatic necrosis was in 24% patients. Other features like diffuse/focal pancreatic enlargement in (75%), peri-pancreatic fat stranding in (64%) and peri-pancreatic fluid collection in (40%). Among this alcohol was the most common cause of AP (84%). The accuracy and sensitivity of serum amylase and serum lipase in diagnosing AP were 40% and 64% respectively with CT showing 100% accuracy and sensitivity. Modified CT severity index was classified as mild (2 and 4), moderate (6) and severe (8 and 10) of which majority were mild (66%), moderate (22%) and severe (12%).Conclusion: Computed tomography is a sensitive, non-invasive imaging in early diagnosis and staging of severity of acute pancreatitis which help in prediction of prognosis of the disease. It helps to differentiate between edematous and necrotizing pancreatitis as serum lipase and amylase levels do not help to differentiate the type of AP. Modified CT severity index helps in evaluating the percentage pancreatic necrosis and to predict the possibility of developing local and systemic complications and necessity of tertiary care.

Assessment of acute pancreatitis using CT severity index and modified CT severity index: A tertiary care hospital based observational study

Background: This study was conducted to assess the correlation with patient outcome and interobserver variability of a modified CT severity index in the evaluation of patients with acute pancreatitis compared with the currently accepted CT severity index. Material and Methods: This is a prospective study, conducted from January 2019 to December 2019, in the Department of Radio Diagnosis, Noor Hospital, Indian Institute of Medical Science and Research (IIMS&R), Warudi, Badnapur. A total of 63 patients referred from the Department of Medicine and Department of Surgery, IIMS & R presented with the chief complaint of epigastric pain, nausea and vomiting and CECT abdomen were suggestive of acute pancreatitis were included in this study. Assessment of Severity: Assessment of severity of acute pancreatitis was done in all cases by Balthazar CTSI scoring and Mortele Modified CTSI scoring. Results: In our study total 63 cases of acute pancreatitis cases were included in the study. These patients underwent CT abdomen and pelvis, later images were reviewed by radiologist. The maximum patients were in the age group of 21 to 40 years [n=31 (49.2%)]. We found that acute pancreatitis was found three times more common in males than in females. Cholelithiasis was found to be most common aetiological factor for acute pancreatitis in 46% cases followed by alcoholic pancreatitis was seen in 28.5% of cases. Majority of the cases were categorized as mild pancreatitis according Balthazar CTSI score. Majority of the cases were categorized as severe pancreatitis using the Modified Mortele CTS score. Whereas, organ failure, moderate and severe category in modified Mortele CTSI, mild, moderate, severe category in Balthazar CTSI. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection and occurrence of organ failure. It could also predict the need for interventional procedures.

Role of modified CT severity index as a prognostic marker of acute pancreatitis

Severe acute pancreatitis can develop in approximately 15 to 25 percent of patients having acute pancreatitis. Early identification of patients at increased risk for morbidity and mortality can be predicted by the severity of disease, and hence the prediction helps in assisting early triage to intensive care units (ICU) and selection of patients for specific interventions.The present prospective prospective cross sectional study done among 55 patients in the Department of Radiodiagnosis, Kamineni Hospitals, L.B. Nagar, Hyderabad.Liver failure followed by respiratory and renal failure were the most commonly associated organ failure with acute pancreatitis. MCTSI and CTSI have comparable accuracy in predicting various organ failure in patients with acute pancreatitis. Both the scoring indices correlated significantly with other outcome indicators of acute pancreatitis also.In most of the cases presence of the necrosis was associated with the end organ failure but it cannot be termed as a causative factor for organe failure.

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Modified CT severity index for evaluation of acute pancreatitis and correlation with patient outcome

Correlation of modified CT Severity Index with Complications of Acute Pancreatitis

Correlation of modified CT Severity Index with Complications of Acute Pancreatitis

Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis

BackgroundThe site and size of extrapancreatic necrosis (EPN) as assessed on computed tomography may influence the severity of acute necrotizing pancreatitis (ANP). The objective of the study was to evaluate the impact of site and size of EPN on the clinical outcomes in patients with acute necrotizing pancreatitis (ANP). Method and materialsThis retrospective study comprised of consecutive patients with ANP who were admitted between January 2017 and March 2019. Patients in whom the initial contrast enhanced CT showed EPN were eligible for inclusion. The site, volume and maximum dimension of EPN were recorded. The severity of AP and modified CT severity index (MCTSI) was calculated. Clinical outcomes were recorded. ResultsA total of 119 patients (mean age, 37.56 years, 91 males) were included. There was a significant association between the location of EPN and the outcome parameters. The left posterior pararenal collections were significantly associated with mortality (P = 0.041), left paracolic gutter collections with the length of hospitalisation (LOH) (P = 0.014), and right paracolic gutter and mesenteric collections with the intensive care unit (ICU) stay (P = 0.024, and P = 0.021, respectively). There was a significant correlation between the volume and the maximum dimension of collection with LOH and ICU stay. The area under the receiver operating characteristic curve for volume, maximum dimension and MCTSI for predicting death was 0.724 (95% CI, 0.612–0.837), 0.644 (95% CI, 0.516–0.772) and 0.574 (95% CI, 0.452–0.696), respectively. ConclusionThe site and size of EPN provide reliable and objective information for assessing clinical outcomes in patients with ANP.

Advantages of Modified Computed Tomography Severity Index of Acute Pancreatitis Over Other Scoring System

Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal Computed Tomography (CT) are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. CT severity index is used to assess prognostic correlation and clinical outcome of acute pancreatitis. Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation.&#x0D; KYAMC Journal Vol. 10, No.-2, July 2019, Page 110-113

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.

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.

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

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

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.

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.