Abstract
Objectives
This study explored the early predictive value of volume and mean CT density of necrosis for adverse outcomes in patients with acute necrotising pancreatitis (ANP).
Methods
A total of 155 patients with ANP who underwent CECT within 7 days of symptom onset were included. The necrosis volume, mean CT density, and modified CT severity index (mCTSI) were calculated. C-reactive protein (CRP) and blood urea nitrogen (BUN) levels both 48 h after symptom onset were reviewed. Adverse outcomes were recorded. The predictive value of each indicator was assessed using ROC curve analysis.
Results
There were significant associations between necrosis volume and mean CT density and organ failure (OF), persistent OF (POF), and need for intervention (p < 0.001 for all). For predicting OF, the area under the curve (AUC) was significantly higher for necrosis volume than for mCTSI and BUN (AUC: 0.84 vs 0.67, p = 0.0011; 0.84 vs 0.71, p = 0.0193, respectively). For predicting POF and need for intervention, the AUCs for necrosis volume were significantly higher than those for mCTSI (AUC: 0.79 vs 0.66, p = 0.0045; 0.77 vs 0.61, p = 0.0019, respectively), but did not significantly differ from those for CRP and BUN. For predicting OF, a significantly better predictive value was achieved with mean CT density than with mCTSI (AUC: 0.79 vs 0.67, p = 0.0163). There were no significant differences in predictive value between mean CT density, CRP, and BUN.
Conclusions
The volume and mean CT density of necrosis based on CECT can provide early prediction of OF, POF, and need for intervention.
Key Points
• Compared to mCTSI, necrosis volume might be used to more accurately diagnose organ failure and persistent organ failure and might be better associated with the need for intervention.
• Necrosis volume and mean CT density based on CECT are reliable quantitative predictors for organ failure, persistent organ failure, and intervention in acute pancreatitis.
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Abbreviations
- ANP:
-
Acute necrotising pancreatitis
- AP:
-
Acute pancreatitis
- BUN:
-
Blood urea nitrogen
- CRP:
-
C-reactive protein
- GIF:
-
Gastrointestinal fistula
- IAH:
-
Intra-abdominal haemorrhage
- ICC:
-
Intraclass correlation coefficient
- IPN:
-
Infected pancreatic necrosis
- mCTSI:
-
modified CT severity index
- NP:
-
Necrotising pancreatitis
- OF:
-
Organ failure
- POF:
-
Persistent organ failure
- RAC:
-
Revised Atlanta classification
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Acknowledgements
We would like to thank Editage (www.editage.cn) for English language editing.
We would like to thank Jiawei Luo, PhD, West China Biomedical Big Data Center, West China Hospital, Sichuan University, for his assistance in the data analysis.
Funding
This study has received funding by the National Natural Science Foundation of China (Grant No. 81902720) and Medical Health Science and Technology Project of Zhejiang Province of China (Grant No. 2020RC015; Grant No. 2018KY396).
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The scientific guarantor of this publication is Feng Guo, MD.
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Jiawei Luo, PhD, West China Biomedical Big Data Center, West China Hospital, Sichuan University provided statistical advice for this manuscript.
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• Retrospective
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Liu, N., He, J., Hu, X. et al. Acute necrotising pancreatitis: measurements of necrosis volume and mean CT attenuation help early prediction of organ failure and need for intervention. Eur Radiol 31, 7705–7714 (2021). https://doi.org/10.1007/s00330-021-07840-x
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DOI: https://doi.org/10.1007/s00330-021-07840-x