Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis

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. KYAMC Journal Vol. 10, No.-2, July 2019, Page 110-113

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Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/642 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3541-3546

Author(s):

Jayaprakash Subramani ◽

Rajesh Prabhu ◽

Jagadeesapandian Palpandi

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Predictive Value ◽

Tamil Nadu ◽

Objective Assessment ◽

Tertiary Care ◽

Severity Index ◽

Apache Ii ◽

Care Hospital ◽

Male Predominance

BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index

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Computed Tomography Severity Index Is an Early Prognostic Tool for Acute Pancreatitis

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(08)70279-4 ◽

2006 ◽

Vol 2006 ◽

pp. 51-53

Author(s):

G.G. Ginsberg

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Severity Index ◽

Prognostic Tool

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Correlation of left ventricular systolic function evaluated by strain rate imaging with computed tomography severity index in patients with acute pancreatitis

World Chinese Journal of Digestology ◽

10.11569/wcjd.v26.i8.524 ◽

2018 ◽

Vol 26 (8) ◽

pp. 524

Author(s):

Tao Shi ◽

Yu Wang ◽

Chuang Li ◽

Wei Zheng

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Strain Rate ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Severity Index ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Strain Rate Imaging

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Role of Computed Tomography In The Evaluation of Severity of Acute Pancreatitis

KYAMC Journal ◽

10.3329/kyamcj.v7i2.33823 ◽

2017 ◽

Vol 7 (2) ◽

pp. 738-744

Author(s):

Md Mofazzal Sharif ◽

Mahfuz Ara Ferdousi ◽

Md Towhidur Rahman ◽

Nayeema Rahman ◽

Md Nayeem Ullah ◽

...

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Clinical Outcome ◽

Surgical Intervention ◽

Gall Stone ◽

Severity Index ◽

Clinical Findings ◽

Time Period ◽

Mild Acute Pancreatitis

Title: Role of computed tomography in the evaluation of severity of acute pancreatitis.Introduction: Early diagnosis and determination of severity of acute pancreatitis is important for management and it depends largely on severity of disease. Medical treatment of mild acute pancreatitis includes conservative management while severe acute pancreatitis requires intensive care to surgical intervention (open or minimally invasive) in selected cases.Methodology: This prospective study was carried out to find out the correlation between modified CT severity index and patient's clinical outcome in acute pancreatitis enrolling 96 subjects in the department of Radiology and Imaging, BIRDEM during two years time period. Severity of acute pancreatitis was assessed by both clinical and imaging staging (Modified CT severity index) in mild, moderate and severe groups.Result: Mean age ( ± SD) of the study subjects was 35.48 ± 14.59 years and number of male was 60 (62.50%) and female was 36 (37.50%). Acute pancreatitis was associated with hypertriglyceridemia (19.79%), gall stone (12.5%), post ERCP (6.25%) and alcoholism (2.08%). Aetiology was unidentified in 59.73% subjects. Majority of the subjects with acute pancreatitis presented with abdominal pain, fever (20.08%), vomiting (54.41%) and oedema (25%). On imaging, diffuse pancreatic enlargement was noted in 29.16% subjects. Pancreatic inflammation with and without peripancreatic fat involvement were observed in 27.08% and 72.91% subjects respectively. Pseudocyst formation (13.54%), ascites (30.20%), renal fascia involvement (46.87%) and pleural effusion (37.5%) were seen in CT scan. Severity of acute pancreatitis was evaluated by clinical findings and CT severity index and the measure of agreement between clinical and imaging staging was almost perfect. CT severity index in acute pancreatitis had statically significant relation with clinical outcome (0.573), organ failure (0.674), need for surgical intervention (0.463) and hospital stay (0.235).Conclusion: Modified CT severity index in acute pancreatitis correlates with patient outcome. During reporting if this simple scoring system is applied then we can easily measure the severity and determine whether patient need medical or surgical intervention.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 738-744

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Relationship of Arterial Changes in Acute Pancreatitis on CT Angiography with Modified CT Severity Index

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1736497 ◽

2021 ◽

Author(s):

Sanya Vermani ◽

Aditya Kaushal ◽

Arshpreet Kaur ◽

Mohit Singla

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Necrotizing Pancreatitis ◽

Fluid Collection ◽

Vascular Complications ◽

Severity Index ◽

Arterial Complications ◽

Acute Necrotizing ◽

Cect Scan ◽

Enhanced Computed Tomography

Abstract Purpose To evaluate the prevalence of arterial changes in patients with acute pancreatitis (AP) on computed tomography angiography (CTA) and determine their association with etiology of AP, presence of necrosis, collections and severity of AP. Materials and Methods A total of 50 patients (20 women, 30 men; mean age: 43.04 ± 13.98; age range: 18–77 years) with AP underwent contrast-enhanced computed tomography (CECT) scan and CTA of abdomen, which was evaluated for necrosis and fluid collection (s). On CTA, splanchnic arterial structures were assessed for vascular complications. Association between vascular changes and presence of necrosis, fluid collections, etiology of AP and severity of AP (as assessed by modified computed tomography severity index CTSI) was determined. Results Arterial complications were seen in 28 percent (14/50). The most frequently involved artery was superior pancreaticoduodenal artery (12 percent), followed by splenic artery (8 percent) and right gastric artery (8 percent; Fig. 1). No significant association was seen between arterial changes and gallstone or alcohol-induced AP. Arterial changes showed a significant association with presence of acute necrotizing pancreatitis (ANP), presence of collections and severe AP (CTSI 8–10) (p < 0.05 for each). Conclusion Arterial changes on CTA are frequently seen in patients of AP having ANP. There is a significant association between arterial changes and presence of necrosis, collections and severe AP.

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