Division of Abdominal Imaging & Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Gastroenterol. 2012 Apr;107(4):612-9. doi: 10.1038/ajg.2011.438. Epub 2011 Dec 20.
The early identification of clinically severe acute pancreatitis (AP) is critical for the triage and treatment of patients. The aim of this study was to compare the accuracy of computed tomography (CT) and clinical scoring systems for predicting the severity of AP on admission.
Demographic, clinical, and laboratory data of all consecutive patients with a primary diagnosis of AP during a two-and-half-year period was prospectively collected for this study. A retrospective analysis of the abdominal CT data was performed. Seven CT scoring systems (CT severity index (CTSI), modified CT severity index (MCTSI), pancreatic size index (PSI), extrapancreatic score (EP), ''extrapancreatic inflammation on CT'' score (EPIC), ''mesenteric oedema and peritoneal fluid'' score (MOP), and Balthazar grade) as well as two clinical scoring systems: Acute Physiology, Age, and Chronic Health Evaluation (APACHE)-II and Bedside Index for Severity in AP (BISAP) were comparatively evaluated with regard to their ability to predict the severity of AP on admission (first 24 h of hospitalization). Clinically severe AP was defined as one or more of the following: mortality, persistent organ failure and/or the presence of local pancreatic complications that require intervention. All CT scans were reviewed in consensus by two radiologists, each blinded to patient outcome. The accuracy of each imaging and clinical scoring system for predicting the severity of AP was assessed using receiver operating curve analysis.
Of 346 consecutive episodes of AP, there were 159 (46%) episodes in 150 patients (84 men, 66 women; mean age, 54 years; age range, 21-91 years) who were evaluated with a contrast-enhanced CT scan (n = 131 episodes) or an unenhanced CT scan (n = 28 episodes) on the first day of admission. Clinically severe AP was diagnosed in 29/159 (18%) episodes; 9 (6%) patients died. Overall, the Balthazar grading system (any CT technique) and CTSI (contrast-enhanced CT only) demonstrated the highest accuracy among the CT scoring systems for predicting severity, but this was not statistically significant. There were no statistically significant differences between the predictive accuracies of CT and clinical scoring systems.
The predictive accuracy of CT scoring systems for severity of AP is similar to clinical scoring systems. Hence, a CT on admission solely for severity assessment in AP is not recommended.
早期识别临床上严重的急性胰腺炎（AP）对于患者的分诊和治疗至关重要。本研究旨在比较 CT 和临床评分系统在入院时预测 AP 严重程度的准确性。
前瞻性收集了两年半期间所有以原发性 AP 诊断的连续患者的人口统计学、临床和实验室数据。对腹部 CT 数据进行了回顾性分析。比较了七种 CT 评分系统（CT 严重指数（CTSI）、改良 CT 严重指数（MCTSI）、胰腺大小指数（PSI）、胰外评分（EP）、“CT 上胰外炎症”评分（EPIC）、“肠系膜水肿和腹腔液”评分（MOP）和 Balthazar 分级）以及两种临床评分系统：急性生理学、年龄和慢性健康评估（APACHE）-II 和床边 AP 严重程度指数（BISAP），以评估它们在入院后 24 小时内预测 AP 严重程度的能力（住院的第一天）。临床上严重的 AP 定义为以下一项或多项：死亡率、持续性器官衰竭和/或需要干预的局部胰腺并发症的存在。所有 CT 扫描均由两位放射科医生进行共识审查，每位放射科医生均对患者的结局不知情。使用接收器操作曲线分析评估每种影像学和临床评分系统预测 AP 严重程度的准确性。
在 346 例连续发作的 AP 中，有 159 例（46%）在 150 例患者（84 名男性，66 名女性；平均年龄 54 岁；年龄范围 21-91 岁）中出现，这些患者在入院的第一天接受了对比增强 CT 扫描（n = 131 例）或未增强 CT 扫描（n = 28 例）。在 159 例中，诊断为临床上严重的 AP 为 29 例（18%）；9 例（6%）患者死亡。总的来说，Balthazar 分级系统（任何 CT 技术）和 CTSI（仅增强 CT）在预测严重程度方面表现出最高的准确性，但这没有统计学意义。CT 和临床评分系统的预测准确性之间没有统计学上的显著差异。
CT 评分系统预测 AP 严重程度的准确性与临床评分系统相似。因此，不建议在入院时仅进行 CT 检查以评估严重程度。
