Emir Sevde Nur, Kumru Hasan, Güner Gülbanu, Acar Aylin, Canbak Tolga
University of Health Sciences, Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
University of Health Sciences, Umraniye Training and Research Hospital, Department of General Surgery, Istanbul, Turkey.
Abdom Radiol (NY). 2025 Apr 10. doi: 10.1007/s00261-025-04931-x.
Early risk stratification is crucial in acute biliary pancreatitis (ABP) to optimize patient management and guide intensive care unit (ICU) admission decisions. Traditional biomarkers and scoring systems have limitations in early severity assessment. This study aimed to evaluate the predictive value of adrenal contrast ratios on contrast-enhanced CT (CECT) as imaging-based biomarkers for ICU admission and prolonged hospitalization in ABP patients.
This retrospective study included 288 ABP patients who underwent CECT within 24 h of admission. Adrenal-to-inferior vena cava (IVC) and adrenal-to-spleen contrast ratios were measured from portal venous phase images. The predictive performance of these ratios for ICU admission was assessed using receiver operating characteristic (ROC) analysis, and their correlation with clinical outcomes was evaluated through regression analysis.
ICU-admitted patients had significantly higher adrenal contrast ratios compared to non-ICU patients (adrenal-to-IVC ratio: 1.15 vs. 0.99, p < 0.001; adrenal-to-spleen ratio: 0.97 vs. 0.75, p < 0.001). ROC analysis demonstrated strong predictive accuracy (AUC = 0.74 for adrenal-to-IVC, AUC = 0.81 for adrenal-to-spleen). Additionally, adrenal contrast ratios correlated significantly with prolonged hospital stay (r = 0.49-0.55, p < 0.001).
Adrenal contrast ratios serve as promising imaging-based biomarkers for early ICU admission prediction and risk stratification in ABP patients. Their integration into clinical decision-making may enhance early management strategies. Further prospective validation is warranted.
早期风险分层对于急性胆源性胰腺炎（ABP）患者优化治疗管理及指导重症监护病房（ICU）收治决策至关重要。传统生物标志物和评分系统在早期严重程度评估方面存在局限性。本研究旨在评估对比增强CT（CECT）上肾上腺对比率作为基于影像的生物标志物对ABP患者入住ICU及延长住院时间的预测价值。
这项回顾性研究纳入了288例入院后24小时内接受CECT检查的ABP患者。从门静脉期图像测量肾上腺与下腔静脉（IVC）的对比率以及肾上腺与脾脏的对比率。使用受试者操作特征（ROC）分析评估这些比率对入住ICU的预测性能，并通过回归分析评估它们与临床结局的相关性。
与非ICU患者相比，入住ICU的患者肾上腺对比率显著更高（肾上腺与IVC对比率：1.15对0.99，p<0.001；肾上腺与脾脏对比率：0.97对0.75，p<0.001）。ROC分析显示出较强的预测准确性（肾上腺与IVC对比率的AUC=0.74，肾上腺与脾脏对比率的AUC=0.81）。此外，肾上腺对比率与住院时间延长显著相关（r=0.49-0.55，p<0.001）。
肾上腺对比率可作为有前景的基于影像的生物标志物，用于早期预测ABP患者入住ICU及进行风险分层。将其纳入临床决策可能会增强早期管理策略。有必要进行进一步的前瞻性验证。
