Value of CT and clinical criteria in assessment of patients with acute pancreatitis.

OBJECTIVE

To re-assess the value of CT and clinical criteria as prognostic and severity indicators in acute pancreatitis and the correlation between them.

METHODS

Sixty-five cases with acute pancreatitis (AP) were included in the study. The hospitalization days, fevering days and overall complications were regarded as clinical endpoints for the patient group. CT criteria used for AP evaluation included Balthazar's plain CT scan score, CT severity index (CTSI) and London's pancreatic size index (PSI) score. Clinical criteria was Ranson score. The correlations between each criterion and the clinical endpoints, and the relation between CT and clinical criteria were analyzed. The power of each criterion and combination of CT and clinical criteria in predicting overall complications of AP were assessed and compared by using a receiver operative characteristic curve (ROC) analysis.

RESULTS

The mean scores of PSI, Ranson among the three groups classified according to overall complications were significantly different. Except Balthazar's plain CT scan criterion, each criterion's mean score in-groups with local complications was significantly higher than that in-group without. The overall complications were significantly more in severe group than that in mild group classified according to each criterion except plain CT scan criterion. Mean days of hospital stay and fevering were significantly longer in severe group with Ranson score than that in mild group. PSI and Ranson score had a linear correlation with fevering days, and Ranson score had a linear correlation with hospitalization days. In CT criteria, only PSI had a linear correlation with Ranson score. The findings of plain CT scan was found to be some laggard compared with that of clinic. ROC analysis showed the largest A(Z) of Ranson score, and there was no A(Z) increase when CT criteria were added to clinical criteria.

CONCLUSION

The predictive values of Ranson and PSI score in AP patients are superior to that of other criteria. CT criteria are superior to clinical criterion in predicting local complications, and short-term CT follow-up examination is important in the evaluation of AP.