Abstract
Background
This study was designed to determine the most important early CT parameters predictive of acute pancreatitis severity.
Methods
Three hundred and seventy-one consecutive patients with acute abdominal pain and hyperamylasemia were enrolled. Three hundred and ten of the 371 patients met our inclusion criteria. Acute pancreatitis severity was evaluated using the 1992 Atlanta criteria. Different CT parameters were reported from the admission abdominal CT by two radiologists blinded from any clinical parameter, but the patients’ age and gender. These variables were fitted in a binary logistic regression model.
Results
Acute pancreatitis was mild in 80% cases, severe in 20% cases and lethal in 12.69% cases. The following CT parameters were significantly associated with the severity of acute pancreatitis: the objective size of the pancreas (P = 0.001), the peripancreatic fat abnormalities (P = 0.001) and the extent of necrosis (P = 0.007). Moreover, the age of the patient revealed itself a highly significant (P = 0.001) indicator of disease severity. The association of the four CT criteria eventually showed a sensitivity of 73% and a specificity of 81% to predict acute pancreatitis severity.
Conclusion
Although these criteria correlated with disease severity, our study identified that morphological CT criteria cannot be used to triage patients with severe and mild acute pancreatitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Neoptolemos JP, et al. (2000) Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet 355(9219):1955–1960
Kylanpaa-Back ML, Kemppainen E, Puolakkainen P (2002) Trypsin-based laboratory methods and carboxypeptidase activation peptide in acute pancreatitis. Jop 3(2):34–48
Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13. Arch Surg 128(5):586–590
Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223(3):603–613
Anglade D, et al. (2000) Is it useful to maintain specific scores for the early determination of the severity of acute pancreatitis? Ann Chir 125(4):325–333
Wilson C, Heath DI, Imrie CW (1990) Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 77(11):1260–1264
Balthazar EJ, et al. (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174(2):331–336
Ranson JH, et al. (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139(1):69–81
Blamey SL, et al. (1984) Prognostic factors in acute pancreatitis. Gut 25(12):1340–1346
Pezzilli R, Billi P, Morselli-Labate AM (1998) Severity of acute pancreatitis: relationship with etiology, sex and age. Hepatogastroenterology 45(23):1859–1864
Halonen KI, et al. (2000) Severe acute pancreatitis: prognostic factors in 270 consecutive patients. Pancreas 21(3):266–271
Company L, et al. (2003) Factors predicting mortality in severe acute pancreatitis. Pancreatology 3(2):144–148
London NJ, et al. (1991) Rapid-bolus contrast-enhanced dynamic computed tomography in acute pancreatitis: a prospective study. Br J Surg 78(12):1452–1456
Clavien PA, et al. (1988) Value of contrast-enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis. A prospective study of 202 patients. Am J Surg 155(3):457–466
Vesentini S, et al. (1993) Prospective comparison of C-reactive protein level, Ranson score and contrast-enhanced computed tomography in the prediction of septic complications of acute pancreatitis. Br J Surg 80(6):755–757
Lankisch PG, et al. (2002) The APACHE II score is unreliable to diagnose necrotizing pancreatitis on admission to hospital. Pancreas 24(3):217–222
Balthazar EJ, Freeny PC, van Sonnenberg E (1994) Imaging and intervention in acute pancreatitis. Radiology 193(2):297–306
Hill MC, et al. (1982) Acute pancreatitis: clinical vs. CT findings. Am J Roentgenol 139(2):263–269
Kemppainen E, et al. (1996) Early localization of necrosis by contrast-enhanced computed tomography can predict outcome in severe acute pancreatitis. Br J Surg 83(7):924–929
Ranson JH, et al. (1985) Computed tomography and the prediction of pancreatic abscess in acute pancreatitis. Ann Surg 201(5):656–665
Paulson EK, et al. (1999) Acute pancreatitis complicated by gland necrosis: spectrum of findings on contrast-enhanced CT. Am J Roentgenol 172(3):609–613
Baron TH, Morgan DE (1999) Acute necrotizing pancreatitis. N Engl J Med 340(18):1412–1417
Balthazar EJ (2002) Staging of acute pancreatitis. Radiol Clin North Am 40(6):1199–1209
Lankisch PG, et al. (2001) Do we need a computed tomography examination in all patients with acute pancreatitis within 72 h after admission to hospital for the detection of pancreatic necrosis? Scand J Gastroenterol 36(4):432–436
Block S, et al. (1986) Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging. Gut 27(9):1035–1042
Rau B, et al. (1997) Surgical treatment of infected necrosis. World J Surg 21(2):155–161
Beger HG, et al. (1997) Natural course of acute pancreatitis. World J Surg 21(2):130–135
Schmid SW, et al. (1999) The role of infection in acute pancreatitis. Gut 45(2):311–316
Acknowledgement
S. Demuylder
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Knoepfli, A.S., Kinkel, K., Berney, T. et al. Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?. Abdom Imaging 32, 111–115 (2007). https://doi.org/10.1007/s00261-006-9034-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-006-9034-y