Early assessment of acute pancreatitis. A comparative study of computed tomography and laboratory tests.

Because the severity of acute pancreatitis is difficult to assess in the early stage, analyses were made of the diagnostic specificity and sensitivity of computed tomography (CT), C-reactive protein (CRP), serum phospholipase A2 and other laboratory parameters. In a series of 88 patients with clinically suspected severe acute pancreatitis, statistically significant differences were found between mild and severe disease in regard to CRP (97.1 vs. 265.7 mg/l), contrast enhancement of the pancreas at CT (45.3 vs. 22.7 Hounsfield units) and phospholipase A2 activity (5.3 vs. 11.2 nmol FFA/ml min). No significant intergroup difference was found in number of prognostic signs (1.7 vs. 4.1) or in extrapancreatic scores at CT (4.4 vs. 6.4). The sensitivity/specificity of different methods in severe pancreatitis were as follows: Prognostic signs 77.5/75%, CRP (greater than 140 mg/l) 100/81%, phospholipase A2 (greater than 11 nmol FFA/ml min) 42/100%, extrapancreatic score at CT (greater than 4) 100/29%, and contrast enhancement of the pancreas (less than 30 HU) 66/100%. Amylase determination was nonspecific (2-4%). The outcome in acute pancreatitis was most accurately predictable with CT or CRP.