Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis.
Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis.
复制标题
DOI：
--
复制
发表时间：
2005-11
期刊：
影响因子：
--
通讯作者：
G. Gürleyik;S. Emir;G. Kilicoglu;A. Arman;A. Sağlam
中科院分区：
文献类型：
--
作者：
G. Gürleyik;S. Emir;G. Kilicoglu;A. Arman;A. Sağlam
背景：评估胰腺炎的严重程度对于这种具有挑战性的疾病的适当管理是重要的。一个高度精确的系统可以预测严重程度，识别严重炎症的局部程度和并发症，有利于患者的预后。目的探讨计算机断层扫描严重程度指数预测急性胰腺炎严重程度的价值，并将其与APACHEⅱ评分和血清CRP浓度的准确性进行比较。前瞻性临床研究。患者55例临床和实验室诊断为急性胰腺炎的连续患者（37例女性，18例男性，平均年龄57岁）。干预措施临床评价、血液生化分析及腹部CT增强检查。入院前5天的计算机断层扫描严重程度指数、血清CRP水平和入院后48小时的临床APACHE II评分。结果根据亚特兰大分级，13例患者有严重胰腺炎。轻、重度胰腺炎组预测指标的平均值分别为：ct严重指数1.26、6.30 (P<0.001)；APACHE II为4.14和8.61 (P<0.001)；CRP分别为96.0 mg/L、192.4 mg/L （P<0.001）。计算CTSI（大于3.85%、98%、92%、95%和95%）、APACHE II（等于或大于7.62%、86%、57%、88%和80%）和CRP（等于或大于150mg /L: 85%、74%、50%、94%和76%）的敏感性、特异性、阳性预测值、阴性预测值和准确性。结论计算机断层扫描严重程度指数是判断急性胰腺炎严重程度的可靠方法；此外，CT还能显示炎症的局部范围及局部并发症的发生情况。
CONTEXT The assessment of the severity of pancreatitis is important for proper management of this challenging disease. A highly accurate system which could predict the severity and identify the local extent and complications of a serious inflammation, is beneficial for patient outcome. OBJECTIVE The aim was to establish the value of the computed tomography severity index in predicting the severity of acute pancreatitis and to compare it with the accuracy of the APACHE II score and serum CRP concentrations. DESIGN Prospective clinical series. PATIENTS Fifty-five consecutive patients (37 women, 18 men; mean age 57 years) with a clinical and laboratory diagnosis of acute pancreatitis. INTERVENTIONS Clinical evaluation, biochemical analysis of blood and contrast-enhanced abdominal CT. MAIN OUTCOME MEASURES Computed tomography severity index within the first 5 days, serum CRP level, and clinical APACHE II score at 48 hours after admission. RESULTS Thirteen patients had severe pancreatitis according to the Atlanta classification. The mean values of predictive markers in the mild and the severe pancreatitis groups were: computed tomography severity index 1.26 and 6.30 (P<0.001); APACHE II 4.14 and 8.61 (P<0.001); and CRP 96.0 mg/L and 192.4 mg/L (P<0.001), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for the CTSI (greater than 3: 85%, 98%, 92%, 95%, and 95%), for APACHE II (equal to, or greater than 7: 62%, 86%, 57%, 88%, and 80%) and for CRP (equal to, or greater than 150 mg/L: 85%, 74%, 50%, 94%, and 76%). CONCLUSION The computed tomography severity index is a reliable method for staging the severity of acute pancreatitis; moreover, CT has the ability of showing the local extent of the inflammation and the occurrence of local complications.