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

Akut pankreatitte radyolojik skorlama sistemlerinin prognostik etkinliği: CTSI ve mCTSI

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

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