Akut pankreatitte radyolojik skorlama sistemlerinin prognostik etkinliği: CTSI ve mCTSI

Year 2023, Volume: 4 Issue: 6, 637 - 641, 31.12.2023

Emine Ayça Şahin Özge Kibici Nuri Havan , Umut Özdamarlar

https://doi.org/10.47582/jompac.1370969

Abstract

Arka Plan: Akut pankreatit (AP), değişken sonuçlar gösteren karmaşık ve öngörülemeyen bir klinik durumdur. Erken risk değerlendirmesi, uyarlanmış müdahaleler ve hastanın sonuçlarının iyileştirilmesi için hayati önem taşır. Bilgisayarlı Tomografi Şiddet İndeksi (CTSI) ve Modifiye Bilgisayarlı Tomografi Şiddet İndeksi (mCTSI), AP şiddetini değerlendirmek için kullanılan radyolojik skorlama sistemleridir.
Yöntemler: AP'de mortaliteyi tahmin etmek için CTSI ve mCTSI'yi karşılaştırmak amacıyla 1 Ocak 2018 ile 31 Aralık 2022 tarihleri arasında tek bir merkezde gerçekleştirilen retrospektif bir çalışma yürüttük. Veriler, 266 uygun erişkin hastanın elektronik kayıtlarından alındı. İstatistiksel analiz, skorlama sistemleri, hasta demografileri, etiyoloji ve mortalite arasındaki ilişkiyi değerlendirdi.
Bulgular: 266 hastanın arasında %9,4'ü hayatını kaybetti. Ölen hastalar (ortalama yaş: 72,09 ± 15,12) sağ kalanlardan (ortalama yaş: 59,93 ± 16,93) daha yaşlıydı. En yaygın etiyoloji safra pankreatitiydi (%58,64). mCTSI, mortalite ve mortalite olmayan gruplar arasında önemli farklar gösterdi (P = 0,026), ancak CTSI göstermedi (P = 0,112). mCTSI için ROC analizi, 0,629 alan altında bir eğri sonucu verdi ve bir Youden indeksi 0,193 (P = 0,044) ile sonuçlandı. mCTSI'nin 3 olarak belirlenen bir kesme değeri, %59,1 duyarlılığı ve %60,2 özgüllüğüne sahipti.
Tartışma: İleri yaş ve safra kaynaklı etiyoloji, artmış mortalite ile ilişkilendirildi. mCTSI, CTSI'ye göre mortaliteyi tahmin etmede üstünlük gösterdi.

Keywords

Akut pankreatit, Skorlama sistemleri, mortalite

Prognostic accuracy of radiological scoring systems in acute pancreatitis: CTSI vs. mCTSI

Abstract

Aims: Acute pancreatitis (AP) is a complex and unpredictable clinical condition with variable outcomes. Early risk assessment is vital for tailored interventions and improved patient outcomes. The computed tomography severity index (CTSI) and modified computed tomography severity index (mCTSI) are radiological scoring systems used to evaluate AP severity.
Methods: We conducted a single-center retrospective study spanning from January 1, 2018, to December 31, 2022, to compare CTSI and mCTSI in predicting mortality in AP. Data were retrieved from our institution’s electronic records for 266 eligible adult patients. Statistical analysis assessed the relationship between scoring systems, patient demographics, etiology, and mortality.
Results: Among the 266 patients, 9.4% died. Mortal patients were older (mean age: 72.09±15.12) than survivors (mean age: 59.93±16.93). The most common etiology was biliary pancreatitis (58.64%). mCTSI showed significant differences between the mortality and non-mortality groups (p=0.026), whereas CTSI did not (p=0.112). The ROC analysis for mCTSI yielded an area under the curve of 0.629, with a Youden index of 0.193 (p=0.044). A mCTSI cut-off of 3 had a sensitivity of 59.1% and specificity of 60.2%.
Conclusion: Advanced age and biliary etiology were associated with increased mortality. mCTSI demonstrated superiority in predicting mortality compared to CTSI.

Keywords

Acute pancreatitis, scoring systems, mortality

References

• Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: Value of CT in establishing prognosis. Radiology. 1990;174(2):331-336.
• Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: Improved correlation with patient outcome. Am J Roentgenol. 2004;183(5):1261-1265.
• Petrov MS, Windsor JA. Classification of the severity of acute pancreatitis: how many categories make sense? Am J Gastroenterol. 2010;105(1):74-76.
• Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology Guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400-1415.
• Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111.
• Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4):e1-e15.
• Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of Mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-1703.
• Gardner TB, Vege SS, Pearson RK, Chari ST, Topazian MD, Clain JE. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol. 2007;5(6):636-641.
• Mounzer R, Langmead CJ, Wu BU,b et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology. 2012;142(7):1476-1482.
• De Waele JJ, Leppäniemi A, De Keulenaer B, De Laet I. Abdominal sepsis. Curr Opin Crit Care. 2013;19(6):591-597.
• Bollen TL, Singh VK, Maurer R, et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol. 2011;106(10):1749-1754.
• Fagenholz PJ, Castillo CF, Harris NS, Pelletier AJ, Camargo Jr CA, US Emergency Department Acute Pancreatitis Severity Study Group. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol. 2007;17(7):491-497.
• Marra F, Renzulli M, Zerboni G. Acute pancreatitis: Multidisciplinary management and emerging therapies. World J Gastroenterol. 2019;25(32):4163-4171.
• Tenner S, Sica G, Hughes M, Noordhoek E. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology. 2003;124(4):A219.
• Johnson CD, Abu-Hilal M, Williamson RC. A radiological scoring system for severity of acute pancreatitis. Pancreas. 2004;29(4):301-312.
• De Bernardinis M, Violi V, Roncoroni L, et al. Contribution of imaging and fine needle aspiration cytology to the diagnosis of chronic pancreatitis: a study in 65 consecutive patients. Dig Liver Dis. 2003;35(11):833-839.
• Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, Windsor JA, Gooszen HG. Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg. 2010;251(4):656-664.,
• Erdogan MÖ, Hokenek NM. How to score acute pancreatitis in the emergency setting: five systems against ED-SAS. Signa Vitae. 2021;1(8).
• Hökenek UD, Aydıner Ö, Kart JS, Arslan G, Saracoglu KT. Evaluation of the effect of pancreatic volume on mortality in patients with acute pancreatitis. Am J Emerg Med. 2023;63:38-43.
• Ibrahim A, Bayramoglu B, Hokenek NM, Tekyol D. Lactate clearance during the first 2 hours after hospital admission: a useful biomarker for predicting 30-day mortality in patients with diabetic ketoacidosis. Int J Clin Pract. 2021;75(7):e14204.
• Hokenek NM, Seyhan AU, Erdoğan MÖ, Tekyol D, Yılmaz Y, Korkut S. Evaluation of blood gas analysis as a mortality predictor. South Clin Ist Euras. 2019;30(3):228-231.