Chiu Hiu Wah, Fung Kin Fen Kevin, Leung Chi Lun Yvonne, Lui Tak Yau Stephan, Hui Wun Fung, Leung Wing-Kwan, Ma Alison Lap-Tak, Chao Nicholas Sik-Yin, Kan Yee Ling Elaine
Department of Radiology, 2/F, Block B, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong.
Pediatr Radiol. 2025 Jul;55(8):1622-1631. doi: 10.1007/s00247-025-06298-z. Epub 2025 Jun 18.
The ability to predict severe pancreatitis in children remains a challenge, and limited evidence exists in the literature regarding the utility of different prognostication systems.
To assess the utility of the modified computed tomography severity index (mCTSI) in predicting clinical outcomes in paediatric patients with acute pancreatitis.
MATERIALS/METHODS: A single-centre, retrospective review of all patients diagnosed with acute pancreatitis who underwent contrast-enhanced computed tomography of the abdomen and pelvis from January 2019 to December 2024. The performance in predicting the development of organ dysfunction of mCTSI, computed tomography severity index (CTSI), and C-reactive protein (CRP) level at 48 h of admission was compared.
We included 47 patients. Patients who developed organ dysfunction had a higher median mCTSI (8 [interquartile range, IQR 6-10]) compared to those who did not (4 [IQR 2-6], P < 0.001). In patients who had mCTSI ≥ 4, i.e. moderate and severe grades, the median length of PICU stay was significantly longer (mCTSI < 4 = 0 [IQR 0-0] days; mCTSI ≥ 4 = 3 [IQR 0-9] days, P < 0.001). Receiver operating characteristic analysis demonstrated mCTSI as a better predictor of organ dysfunction with an area under curve (AUC) of 0.891 (95% confidence interval [CI] 0.799-0.983), compared to CRP level which had an AUC of 0.596 (95% CI 0.433-0.759) (P = 0.002). No significant difference was identified between mCTSI and CTSI.
Both mCTSI and CTSI were useful in predicting the clinical outcome of patients with acute pancreatitis and performed better than CRP level in predicting the development of organ dysfunction.
预测儿童重症胰腺炎的能力仍然是一项挑战，而且关于不同预后系统效用的文献证据有限。
评估改良计算机断层扫描严重程度指数（mCTSI）在预测小儿急性胰腺炎患者临床结局中的效用。
材料/方法：对2019年1月至2024年12月期间所有诊断为急性胰腺炎并接受腹部和盆腔增强计算机断层扫描的患者进行单中心回顾性研究。比较入院48小时时mCTSI、计算机断层扫描严重程度指数（CTSI）和C反应蛋白（CRP）水平在预测器官功能障碍发生方面的表现。
我们纳入了47例患者。发生器官功能障碍的患者的mCTSI中位数（8[四分位数间距，IQR 6 - 10]）高于未发生器官功能障碍的患者（4[IQR 2 - 6]，P < 0.001）。在mCTSI≥4的患者中，即中度和重度等级，儿科重症监护病房（PICU）住院时间中位数显著更长（mCTSI < 4 = 0[IQR 0 - 0]天；mCTSI≥4 = 3[IQR 0 - 9]天，P < 0.001）。受试者工作特征分析表明，mCTSI是器官功能障碍的更好预测指标，曲线下面积（AUC）为0.891（95%置信区间[CI] 0.799 - 0.983），而CRP水平的AUC为0.596（95% CI 0.433 - 0.759）（P = 0.002）。mCTSI和CTSI之间未发现显著差异。
mCTSI和CTSI在预测急性胰腺炎患者的临床结局方面均有用，且在预测器官功能障碍发生方面比CRP水平表现更好。
