Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation

Abstract

Treatment of patients with acute pancreatitis is based on the initial assessment of disease severity. Severe pancreatitis occurs in 20%-30% of all patients with acute pancreatitis and is characterized by a protracted clinical course, multiorgan failure, and pancreatic necrosis. Early staging is based on the presence and degree of systemic failure (cardiovascular, pulmonary, renal) and on the presence and extent of pancreatic necrosis. Individual laboratory indexes (markers of pancreatic injury, markers of inflammatory response), while promising, have not yet gained clinical acceptance. Numeric grading systems with sensitivities of about 70% are commonly used today as indicators of organ failure and disease severity. Contrast material-enhanced computed tomography is used in addition to help evaluate local pancreatic morphology and the presence and extent of pancreatic necrosis. Advantages and limitations of the clinical, laboratory, and imaging prognostic indexes are analyzed and discussed.

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

“…Our study confirmed the importance of pancreatic necrosis in determining disease severity as previously reported [4,[13][14][15][16][17][18]. Indeed, the risks of acute pancreatitis are most of all infectious complications that are directly linked to the presence of necrosis, a favourable environment to the development of bacteria [3,7,[19][20][21][22][23][24][25][26][27][28].…”

“…Indeed no mortality was reported in low CTSI scores whereas a 17% mortality was associated with high scores. However, the usefulness appears questionable for clinical management of patients with an intermediate score (3)(4)(5)(6) that is associated with a 6% mortality rate. Indeed in our patient population, even with an optimized cutoff point, the sensitivity does not exceed 80% with a specificity of 55% (Table 4).…”

“…Indeed predicting the severity of acute pancreatitis remains a cornerstone, as no simple and effective diagnostic tool is available yet. None of the present criteria allows to predict the severity of acute pancreatitis with sufficient accuracy (clinical Ranson, Acute Physiology and Chronic Health Evaluation-APACHE II, modified Glasgow and Balthazar radiological scores) [4][5][6]. In addition, no specific management and therapeutical approach have emerged.…”

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre

“…Use of CT scan was recorded and Balthazar CT severity score calculated for the purposes of the study [19]. For tertiary transfer patients, the information relating to CT refer to scans undertaken in this centre.…”

Can C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study

“…The CRP test is widely available in laboratories, and various researchers have suggesting using CRP as a prognostic marker for severe AP (9). However, a primary problem is the lack of specificity to predict severe AP at a level not greater than 80% (2,10,11).…”