Evaluation of the Role of Computed Tomography Imaging Findings in Determining The Prognosis in Acute Pancreatitis Case by Comparison with Ranson Criteria

Year 2023, Volume: 14 Issue: 3, 424 - 429, 10.07.2023

Osman Kula Burak Uslu Burak Günay İbrahim Ethem Cakcak

https://doi.org/10.31067/acusaglik.1272355

Abstract

Background/Purpose:
Acute pancreatitis (AP) progresses with pathological changes. Therefore, the prognosis of the disease can be quite variable. In severe pancreatitis, local or systemic complications with high mortality may occur. Treatment of patients after diagnosis of AP depends on early assessment of disease severity. In this study, we aimed to evaluate the effectiveness of predicting pancreatitis severity and prognosis by comparing computerized tomography (CT) scan findings with Ranson criteria.
Methods:
Patients aged 18 years and over who applied to our hospital with the diagnosis of AP between January 2018 and December 2020 were included in the study. We retrospectively analyzed 190 patients in order to determine the severity and prognosis of pancreatitis by comparing CT scan findings and Ranson criteria. Demographic, clinical, radiological and laboratory data of the patients at the time of admission were retrospectively analyzed. In laboratory data, hematocrit (HTC) decrease, blood urea nitrogen (BUN) increase, serum calcium (Ca) level, partial arterial oxygen pressure (PaO2), base deficit and fluid sequestration were evaluated. On CT findings, pancreatic expansion, pancreatic density, peripancreatic fluid collection, intra-abdominal ascites, peripancreatic fatty tissue heterogeneity, presence of peripancreatic lymph nodes, Wirsung duct diameter, presence of pathology in the gallbladder, hepatosteatosis, splenomegaly, splenic vein diameter were assessed.
Results:
A statistically significant difference was found in the comparison of the degree of peripancreatic fluid collection and the severity of pancreatitis. There was no statistically significant difference in our other comparisons.
Conclusion:
In general, studies are dominated by the opinion that the presence of necrosis in patients with AP may be a criterion for determining the prognosis. In our study, it was determined that the presence or absence of pancreatic necrosis in the CT performed at the time of admission was not a prognostic predictor. However, follow-up of necrosis in control imaging can be a marker in determining the prognosis.

Keywords

acute necrotizing pancreatitis, prognosis, computerized tomography

References

• Garg PK, Singh VP. Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology. 2019;156(7):2008-23.
• Bradley EL, 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586-90.
• Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol. 1999;25(3):195-210.
• Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
• Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res. 1977;22(2):79-91.
• Balthazar EJ. Staging of acute pancreatitis. Radiol Clin North Am 2002;40(6):1199-209.
• Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 2012;262(3):751-64.
• Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med 2018;55(6):769-79.
• Leung TK, Lee CM, Lin SY, Chen HC, Wang HJ, Shen LK, et al. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol. 200514;11(38):6049-52.
• Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331-6.
• Aphinives P, Karunasumetta C, Bhudhisawasdi V, Saesaew OT. Acute pancreatitis: assessment severity with Ranson score and CT evaluation. J Med Assoc Thai. 2011;94(4):437-40.
• Chand P, Singh R, Singh D, Rani N. Evaluation of the outcome of acute pancreatitis by Ranson’s criteria and modified CT severity index. Renal failure. 2017;2(2):4-25.
• Harshit Kumar A, Singh Griwan M. A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterology report. 2018;6(2):127-31.
• Meyrignac O, Lagarde S, Bournet B, Mokrane FZ, Buscail L, Rousseau H, et al. Acute Pancreatitis: Extrapancreatic Necrosis Volume as Early Predictor of Severity. Radiology. 2015;276(1):119-28.
• Knoepfli AS, Kinkel K, Berney T, Morel P, Becker CD, Poletti PA. Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis? Abdom Imaging. 2007;32(1):111-5.