A Comparative Evaluation of Radiologic and Clinical Scoring Systems in the Early Prediction of Severity in Acute Pancreatitis
A Comparative Evaluation of Radiologic and Clinical Scoring Systems in the Early Prediction of Severity in Acute Pancreatitis
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DOI：
10.1038/ajg.2011.438
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发表时间：
2012-04-01
影响因子：
9.8
通讯作者：
Mortele, Koenraad J.
中科院分区：
文献类型：
--
作者：
Bollen, Thomas L.;Singh, Vikesh K.;Mortele, Koenraad J.
结论：临床重症急性胰腺炎（AP）的早期识别对于患者的分诊和治疗至关重要。本研究的目的是比较计算机断层扫描（CT）和临床评分系统预测AP的严重程度accounting.METHODS的准确性：人口统计学，临床和实验室数据的所有连续患者的主要诊断AP在两年半的时间内，前瞻性地收集本研究。对腹部CT数据进行回顾性分析。7种CT评分系统（CT严重性指数（CTSI）、改良CT严重性指数（MCTSI）、胰腺大小指数（PSI）、胰腺外评分（EP）、“CT胰腺外炎症”评分（EPIC）、“肠系膜水肿和腹膜液”评分（MOP）和Balthazar分级）以及两个临床评分系统：急性生理学，年龄，和慢性健康评估（APACHE）-II和床边严重程度指数在AP（BISAP）进行了比较，评价他们的能力，以预测严重程度的AP入院（第一个24小时的住院）。临床重度AP定义为以下一项或多项：死亡、持续性器官衰竭和/或存在需要干预的局部胰腺并发症。所有CT扫描均由两名放射科医生一致审查，每位放射科医生均对患者结局不知情。结果：在346例连续发作的AP中，150例患者中有159例（46%）发作男84例，女66例，平均年龄54岁;年龄范围，21-91岁），在入院第一天进行对比增强CT扫描（n=131次发作）或非增强CT扫描（n=28次发作）。在29/159例（18%）发作中诊断为临床重度AP; 9例（6%）患者死亡。总体而言，Balthazar分级系统（任何CT技术）和CTSI（仅对比增强CT）在预测严重程度的CT评分系统中显示出最高的准确性，但这并不具有统计学意义。CT和临床评分system.CONCLUSIONS：AP的严重程度的CT评分系统的预测准确性与临床评分系统的预测准确性之间没有统计学显着差异。因此，不建议在入院时仅进行CT以评估AP的严重程度。
OBJECTIVES: The early identification of clinically severe acute pancreatitis (AP) is critical for the triage and treatment of patients. The aim of this study was to compare the accuracy of computed tomography (CT) and clinical scoring systems for predicting the severity of AP on admission.METHODS: Demographic, clinical, and laboratory data of all consecutive patients with a primary diagnosis of AP during a two-and-half-year period was prospectively collected for this study. A retrospective analysis of the abdominal CT data was performed. Seven CT scoring systems (CT severity index (CTSI), modified CT severity index (MCTSI), pancreatic size index (PSI), extrapancreatic score (EP), "extrapancreatic inflammation on CT" score (EPIC), "mesenteric oedema and peritoneal fluid" score (MOP), and Balthazar grade) as well as two clinical scoring systems: Acute Physiology, Age, and Chronic Health Evaluation (APACHE)-II and Bedside Index for Severity in AP (BISAP) were comparatively evaluated with regard to their ability to predict the severity of AP on admission (first 24 h of hospitalization). Clinically severe AP was defined as one or more of the following: mortality, persistent organ failure and/or the presence of local pancreatic complications that require intervention. All CT scans were reviewed in consensus by two radiologists, each blinded to patient outcome. The accuracy of each imaging and clinical scoring system for predicting the severity of AP was assessed using receiver operating curve analysis.RESULTS: Of 346 consecutive episodes of AP, there were 159 (46%) episodes in 150 patients (84 men, 66 women; mean age, 54 years; age range, 21-91 years) who were evaluated with a contrastenhanced CT scan (n=131 episodes) or an unenhanced CT scan (n=28 episodes) on the first day of admission. Clinically severe AP was diagnosed in 29/159 (18%) episodes; 9 (6%) patients died. Overall, the Balthazar grading system (any CT technique) and CTSI (contrast-enhanced CT only) demonstrated the highest accuracy among the CT scoring systems for predicting severity, but this was not statistically significant. There were no statistically significant differences between the predictive accuracies of CT and clinical scoring systems.CONCLUSIONS: The predictive accuracy of CT scoring systems for severity of AP is similar to clinical scoring systems. Hence, a CT on admission solely for severity assessment in AP is not recommended.