OBJECTIVES: Our main purpose was to compare the Modified CT Severity Index (MCTSI), CT Severity Index (CTSI) and Acute Physiological, Age, and Chronic Health Evaluation (APACHE-II) predictions regarding severity according to Atlanta Classification 2012 and local complications in acute pancreatitis in a consecutive prospective cohort. METHODS: 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 multi-organ failure, length of hospitalization, the need for intensive care, death and local complications (intervention against necrosis and infected necrosis). The area under the curve (AUC) was evaluated and the scoring systems underwent a prospective comparison. RESULTS: Both CTSI and MCTSI were associated significantly with all the evaluated severity parameters and showed a correlation between image severity and worst clinical outcomes. Persistent organ failure, persistent multi-organ failure, and death were found in 30 (20.1%), 20 (13.4%) and 13 (8.7%) patients, respectively. The most common extra-pancreatic finding was pleural effusion in 76 patients. (51%). The AUC for CTSI was higher for predicting persistent organ failure (AUC 0.749 95% CI: 0.64-0.857), death (AUC 0.79395% CI: 0.650-0.936), intervention against necrosis (AUC 0.862 95% CI 0.779-0.945) and infected necrosis (AUC 0.949 95% CI 0.882-1). CONCLUSIONS: CT indexes outperformed the classic APACHE-II for evaluating severity parameters, with a slight advantage of CTSI over MCTSI. CTSI accurately predicted pancreatic infections and the need for intervention. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
OBJECTIVES: Our main purpose was to compare the Modified CT Severity Index (MCTSI), CT Severity Index (CTSI) and Acute Physiological, Age, and Chronic Health Evaluation (APACHE-II) predictions regarding severity according to Atlanta Classification 2012 and local complications in acute pancreatitis in a consecutive prospective cohort. METHODS: 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 multi-organ failure, length of hospitalization, the need for intensive care, death and local complications (intervention against necrosis and infected necrosis). The area under the curve (AUC) was evaluated and the scoring systems underwent a prospective comparison. RESULTS: Both CTSI and MCTSI were associated significantly with all the evaluated severity parameters and showed a correlation between image severity and worst clinical outcomes. Persistent organ failure, persistent multi-organ failure, and death were found in 30 (20.1%), 20 (13.4%) and 13 (8.7%) patients, respectively. The most common extra-pancreatic finding was pleural effusion in 76 patients. (51%). The AUC for CTSI was higher for predicting persistent organ failure (AUC 0.749 95% CI: 0.64-0.857), death (AUC 0.79395% CI: 0.650-0.936), intervention against necrosis (AUC 0.862 95% CI 0.779-0.945) and infectednecrosis (AUC 0.949 95% CI 0.882-1). CONCLUSIONS: CT indexes outperformed the classic APACHE-II for evaluating severity parameters, with a slight advantage of CTSI over MCTSI. CTSI accurately predicted pancreatic infections and the need for intervention. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Entities:
Keywords:
CT index; acute pancreatitis; local complications; organ failure; severity
Authors: Nils Jimmy Hidalgo; Elizabeth Pando; Piero Alberti; Laura Vidal; Rodrigo Mata; Nair Fernandez; Maria Jose Gomez-Jurado; Cristina Dopazo; Laia Blanco; Stephanie Tasayco; Xavier Molero; Joaquim Balsells; Ramon Charco Journal: World J Surg Date: 2022-03-30 Impact factor: 3.282