Prognostic value of early computed tomographic scans in severe acute pancreatitis. French Association for Surgical Research.

BACKGROUND

The prognostic value of computed tomographic (CT) scans in differentiating mild from severe forms of acute pancreatitis is well established. Nonetheless, in patients with a severe form of the disease, some will have a relatively uneventful course while others will have severe complications. This prospective, multicenter study was done to evaluate the prognostic value of early CT scan in a homogenous group of patients with a first attack of severe acute pancreatitis.

STUDY DESIGN

Dynamic CT scans were performed within 48 hours after admission. A standardized form was completed for each CT scan, recording the following data: abnormal enhancement of the pancreas itself, characteristics of extrapancreatic collections, and visualization of the portal and splenic veins. Statistical analysis was based on the log rank test and Cox's model and used death and abscess occurrence as the two end points.

RESULTS

Two hundred twenty-eight patients from 46 centers were included in the study. The median Ranson and Imrie scores were 3 and 4, respectively. Forty-seven patients died and 72 had an abscess. The CT scan findings indicating an increase in mortality rate were nonenhancement of the neck of the pancreas (p = 0.04) and extrapancreatic collections within the left (p = 0.001) and right (p = 0.02) pararenal posterior spaces. The risk of abscess increased when there was nonvisualization of the splenic vein (p = 0.0001), in the presence of extrapancreatic collections in the right pararenal posterior space (p = 0.03) and when the extrapancreatic collections were heterogenous (p = 0.003).

CONCLUSIONS

This study demonstrated that the location of extrapancreatic collections and nonvisualization of the splenic and portal veins on CT scans were not previously recognized prognostic factors of complicated outcome in patients with severe acute pancreatitis.