Better Prediction of Severity in Acute Pancreatitis Using Radiological Criteria.

Abstract

Background: Acute pancreatitis is inflammation of the pancreas. Severe cases can lead to multi-organ dysfunction. So accurate prediction of severity is of great importance to improve survival. For the prediction of severity, there are several criteria. In this study, we have compared clinical criteria and imaging criteria to detect the severity of acute pancreatitis. In clinical criteria, we have taken Ranson criteria and BISAP(Bedside Index for Severity of Acute Pancreatitis) score. In imaging, we have taken MCTSI(Modified Computed Tomography Severity Index). Method: 50 patients (45 males & 05 females) in the age group of 15-65 years with a diagnosis of acute pancreatitis, admitted to a tertiary government hospital from July 2017 to June 2019 were included. BISAP score, Ranson criteria, and MCTSI were calculated for all the cases. Then Ranson and BISAP criteria were compared with MCTSI, deciding optimum cut-offs for these scorings, by obtaining the area under the curve analysis. Results: As per Atlanta classification, 31 cases were mild, 8 cases categorized as severe and 11 were grouped as moderately severe acute pancreatitis. Out of 50 cases, Pancreatic necrosis was found in 13 cases. Similarly, 15 patients landed in organ failure. The AUC for MCTSI was found to be consistently higher for predicting severe acute pancreatitis (0.958), pancreatic necrosis (0.942), organ failure (0.941) than Ranson criteria and BISAP criteria. The AUC for Ranson and BISAP criteria in predicting severe acute pancreatitis was 0.904 and 0.874, predicting pancreatic necrosis was 0.876 and 0.896 & in predicting organ failure was 0.881 and 0.880 respectively. Conclusion: MCTSI is more effective in detecting severe acute pancreatitis, organ failure, and pancreatic necrosis. So, the CECT scan is a better and simpler tool to detect the severity objectively for acute pancreatitis.