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Acute necrotising pancreatitis: measurements of necrosis volume and mean CT attenuation help early prediction of organ failure and need for intervention

  • Hepatobiliary-Pancreas
  • Published:
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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).

Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Nan Liu, Wei Su & Feng Guo

  2. Center of Severe Pancreatitis, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Nan Liu, Wei Su & Feng Guo

  3. Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Jie He & Xi Hu

  4. Department of Radiology, People’s Hospital of Quzhou, Quzhou, China

    Shu-Feng Xu

  5. Laboratory of Cancer Biology, Key Laboratory of Biotherapy of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Jing-Feng Luo

  6. Department of Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Qiang-Feng Wang

Authors
  1. Nan Liu
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  2. Jie He
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  3. Xi Hu
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  5. Wei Su
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  8. Feng Guo
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Corresponding author

Correspondence to Feng Guo.

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Guarantor

The scientific guarantor of this publication is Feng Guo, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Jiawei Luo, PhD, West China Biomedical Big Data Center, West China Hospital, Sichuan University provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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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

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