JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2018 Month : July Volume : 5 Issue : 28 Page : 2105-2109

CT EVALUATION IS MUST FOR PROGNOSIS PREDICTION IN ACUTE PANCREATITIS; RESULTS OF A TWO YEAR PROSPECTIVE STUDY

Brajendra Nath Tripathi1, Rajeev Sethi2, Sandhya Pandey3

Corresponding Author:
Dr. Sandhya Pandey,
Senior Consultant,
Arvind Imaging Centre,
Jhunsi. Allahabad.
E-mail: brajendranath@gmail.com
DOI: 10.18410/jebmh/2018/436

ABSTRACT
BACKGROUND
This study emphasizes the importance of computed tomography (CT) imaging in acute pancreatitis to grade clinical severity and predict outcome. The clinical and radiological findings in acute pancreatitis were correlated to predict the severity of the disease and its prognosis.

MATERIALS AND METHODS
Selected patients with clinical diagnosis of acute pancreatitis were evaluated clinically using Ranson’s criteria and then by CT scan for Balthazar grading and CT severity index (CTSI).

RESULTS
In our prospective study of 91 patients of acute pancreatitis, the male:female ratio was approximately 2:1 and the aetiological agents were mainly alcoholism (41) seen predominantly in males and cholelithiasis (32) which was more in females. The Ranson’s score of acute pancreatitis was calculated based on appropriate laboratory data and divided into two groups - mild in 51 and severe in 40 patients. The findings on CT scan were taken as standard for classifying acute pancreatitis into mild (57) and severe (34) forms based on Balthazar CTSI. 5 patients with severe form had prolonged hospital stay (>20 days). Also 5 patients had expired during the study duration (5.5 %) and they had severe form. The sensitivity and specificity of Ranson’s criteria to correctly prognosticate the severity of acute pancreatitis were 86% and 68% respectively on correlation with Balthazar’s CTSI. The discrepancy between Ranson’s and Balthazar’s CTSI in assessing the severity of acute pancreatitis existed in approximately 22% of the cases.

CONCLUSION
The Balthazar’s CTSI based classification is superior to Ranson’s scoring system in prediction and prognostication of severity of acute pancreatitis as computed tomography study provides direct visualization of anatomical distortion and pathological extension of disease process in acute pancreatitis, with particular emphasis on pancreatic necrosis.

KEYWORDS
Acute pancreatitis, computed tomography, necrosis, severity index, prognosis.