Peng Rong, Zhang Ling, Zhang Ze-Ming, Wang Zhi-Qing, Liu Guang-Yu, Zhang Xiao-Ming
Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China.
Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Quant Imaging Med Surg. 2020 Feb;10(2):451-463. doi: 10.21037/qims.2019.12.14.
To study the predictive value of semi-quantitative pleural effusion and pulmonary consolidation for acute pancreatitis (AP) severity.
Thorax-abdominal computed tomography (CT) examinations were performed on 309 consecutive AP patients in a single center. Among them, 196 were male, and 113 were female, and the average age was 50±16 years. The etiology of AP was biliary in 43.7% (n=135), hyperlipidemia in 22.0% (n=68), alcoholic in 7.4% (n=23), trauma in 0.6% (n=2), and postoperative status in 1.6% (n=5) cases; 24.6% (n=76) of patients did not have specified etiologies. The prevalence of pleural effusion and pulmonary consolidation was noted. The pleural effusion volume was quantitatively derived from a CT volume evaluation software tool. The pulmonary consolidation score was based on the number of lobes involved in AP. Each patient's CT severity index (CTSI), acute physiology and chronic health evaluation II (APACHE II) scoring system, and bedside index for severity in acute pancreatitis (BISAP) scores were obtained. The semi-quantitative pleural effusion and pulmonary consolidation were compared to these scores and clinical outcomes by receiver operator characteristic (ROC) curve and area under the curve (AUC) analysis.
In the 309 patients, 39.8% had pleural effusion, and 47.9% had pulmonary consolidation. The mean pleural effusion volume was 41.7±38.0 mL. The mean pulmonary consolidation score was 1.0±1.2 points. The mean CTSI was 3.7±1.8 points, the mean APACHE II score was 5.8±5.1 points, and the mean BISAP score was 1.3±1.0 points; 5.5% of patients developed severe AP, and 13.9% of patients developed organ failure. Pleural effusion volume and pulmonary consolidation scores correlated to the scores for the severity of AP. In predicting severe AP, the accuracy (AUC 0.839) of pleural effusion volume was similar to that of the CTSI score (P=0.961), APACHE II score (P=0.757), and BISAP score (P=0.906). The accuracy (AUC 0.805) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.503), APACHE II score (P=0.343), and BISAP score (P=0.669). In predicting organ failure, the accuracy (AUC 0.783) of pleural effusion volume was similar to that of the CTSI score (P=0.473), APACHE II score (P=0.119), and BISAP score (P=0.980), and the accuracy (AUC 0.808) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.236), APACHE II score (P=0.293), and BISAP score (P=0.612).
Pleural effusion and pulmonary consolidation are common in AP and correlated to the severity of AP. Furthermore, the pleural effusion volume and pulmonary consolidation lobes can provide early prediction of severe AP and organ failure.
研究胸腔积液半定量及肺实变对急性胰腺炎（AP）严重程度的预测价值。
对单中心309例连续性AP患者进行胸腹部计算机断层扫描（CT）检查。其中男性196例，女性113例，平均年龄50±16岁。AP的病因中，胆源性占43.7%（n = 135），高脂血症性占22.0%（n = 68），酒精性占7.4%（n = 23），创伤性占0.6%（n = 2），术后状态占1.6%（n = 5）；24.6%（n = 76）的患者病因未明确。记录胸腔积液和肺实变的发生率。胸腔积液量通过CT容积评估软件工具进行定量测定。肺实变评分基于AP累及的肺叶数量。获取每位患者的CT严重指数（CTSI）、急性生理与慢性健康状况评分系统II（APACHE II）及急性胰腺炎严重程度床边指数（BISAP）评分。通过受试者工作特征（ROC）曲线及曲线下面积（AUC）分析，比较胸腔积液半定量及肺实变与上述评分及临床结局的关系。
309例患者中，39.8%有胸腔积液，47.9%有肺实变。胸腔积液平均量为41.7±38.0 mL。肺实变平均评分为1.0±1.2分。CTSI平均分为3.7±1.8分，APACHE II平均评分为5.8±5.1分，BISAP平均评分为1.3±1.0分；5.5%的患者发生重症AP，13.9%的患者发生器官衰竭。胸腔积液量及肺实变评分与AP严重程度评分相关。在预测重症AP方面，胸腔积液量的准确性（AUC 0.839）与CTSI评分（P = 0.961）、APACHE II评分（P = 0.757）及BISAP评分（P = 0.906）相似。肺实变评分的准确性（AUC 0.805）也与CTSI评分（P = 0.503）、APACHE II评分（P = 0.343）及BISAP评分（P = 0.669）相似。在预测器官衰竭方面，胸腔积液量的准确性（AUC 0.783）与CTSI评分（P = 0.473）、APACHE II评分（P = 0.119）及BISAP评分（P = 0.980）相似，肺实变评分的准确性（AUC 0.808）也与CTSI评分（P = 0.236）、APACHE II评分（P = 0.293）及BISAP评分（P = 0.612）相似。
胸腔积液和肺实变在AP中常见，且与AP严重程度相关。此外，胸腔积液量及肺实变肺叶可对重症AP和器官衰竭进行早期预测。
