使用增强 CT 检测低增强胰腺实质坏死对预测重症急性胰腺炎临床结局的价值优于胰腺炎症：一项多中心重症急性胰腺炎队列研究。

Early detection of necrosis in low-enhanced pancreatic parenchyma using contrast-enhanced computed tomography was a better predictor of clinical outcomes than pancreatic inflammation: A multicentric cohort study of severe acute pancreatitis.

机构信息

Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka City, Osaka, 545-8585, Japan; Department of Emergency and Critical Care Medicine, Tokyo Human Health Sciences University Vietnam, GD-02, BV-02, Van Giang Urban and Commercial Area (Ecopark), Van Giang District, Hung Yen Province, Viet Nam.

Division of Gastroenterology and Hepatology Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.

出版信息

Pancreatology. 2024 Sep;24(6):827-833. doi: 10.1016/j.pan.2024.07.001. Epub 2024 Jul 4.

DOI:10.1016/j.pan.2024.07.001

PMID:38991872

Abstract

OBJECTIVES

We aim to assess the early use of contrast-enhanced computed tomography (CECT) of patients with severe acute pancreatitis (SAP) using the computed tomography severity index (CTSI) in prognosis prediction. The CTSI combines quantification of pancreatic and extrapancreatic inflammation with the extent of pancreatic necrosis.

METHODS

Post-hoc retrospective analysis of a large, multicentric database (44 institutions) of SAP patients in Japan. The area under the curve (AUC) of the CTSI for predicting mortality and the odds ratio (OR) of the extent of pancreatic inflammation and necrosis were calculated using multivariable analysis.

RESULTS

In total, 1097 patients were included. The AUC of the CTSI for mortality was 0.65 (95 % confidence interval [CI:] [0.59-0.70]; p < 0.001). In multivariable analysis, necrosis 30-50 % and >50 % in low-enhanced pancreatic parenchyma (LEPP) was independently associated with a significant increase in mortality, with OR 2.04 and 95 % CI 1.01-4.12 (P < 0.05) and OR 3.88 and 95 % CI 2.04-7.40 (P < 0.001), respectively. However, the extent of pancreatic inflammation was not associated with mortality, regardless of severity.

CONCLUSIONS

The degree of necrosis in LEPP assessed using early CECT of SAP was a better predictor of mortality than the extent of pancreatic inflammation.

摘要

目的

我们旨在使用 CT 严重指数（CTSI）评估重症急性胰腺炎（SAP）患者的早期增强 CT 检查对预后的预测价值。CTSI 结合了胰腺和胰外炎症的量化与胰腺坏死的程度。

方法

这是一项在日本的大型多中心数据库（44 家机构）中对 SAP 患者进行的回顾性事后分析。使用多变量分析计算 CTSI 预测死亡率的曲线下面积（AUC）和胰腺炎症与坏死程度的比值比（OR）。

结果

共纳入 1097 例患者。CTSI 对死亡率的 AUC 为 0.65（95%置信区间[CI]：[0.59-0.70]；p<0.001）。多变量分析显示，低增强胰腺实质（LEPP）中坏死 30-50%和>50%与死亡率显著增加相关，OR 分别为 2.04 和 95%CI 1.01-4.12（P<0.05）和 OR 3.88 和 95%CI 2.04-7.40（P<0.001）。然而，胰腺炎症的程度与死亡率无关，无论严重程度如何。