JOMPAC

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

EndNote Style
Index
Original Article
Prognostic accuracy of radiological scoring systems in acute pancreatitis: CTSI vs. mCTSI
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.


1. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acutepancreatitis: Value of CT in establishing prognosis. Radiology.1990;174(2):331-336.
2. Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severityindex for evaluating acute pancreatitis: Improved correlationwith patient outcome. Am J Roentgenol. 2004;183(5):1261-1265.
3. Petrov MS, Windsor JA. Classification of the severity ofacute pancreatitis: how many categories make sense? Am JGastroenterol. 2010;105(1):74-76.
4. Tenner S, Baillie J, DeWitt J, Vege SS. American College ofGastroenterology Guideline: management of acute pancreatitis.Am J Gastroenterol. 2013;108(9):1400-1415.
5. Banks PA, Bollen TL, Dervenis C, et al. Classification of acutepancreatitis—2012: revision of the Atlanta classification anddefinitions by international consensus. Gut. 2013;62(1):102-111.
6. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acutepancreatitis. Pancreatology. 2013;13(4):e1-e15.
7. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA.The early prediction of Mortality in acute pancreatitis: a largepopulation-based study. Gut. 2008;57(12):1698-1703.
8. Gardner TB, Vege SS, Pearson RK, Chari ST, Topazian MD, ClainJE. Fluid resuscitation in acute pancreatitis. Clin GastroenterolHepatol. 2007;5(6):636-641.
9. Mounzer R, Langmead CJ, Wu BU,b et al. Comparison ofexisting clinical scoring systems to predict persistent organfailure in patients with acute pancreatitis. Gastroenterology.2012;142(7):1476-1482.
10. De Waele JJ, Leppäniemi A, De Keulenaer B, De Laet I.Abdominal sepsis. Curr Opin Crit Care. 2013;19(6):591-597.
11. Bollen TL, Singh VK, Maurer R, et al. A comparative evaluationof radiologic and clinical scoring systems in the earlyprediction of severity in acute pancreatitis. Am J Gastroenterol.2011;106(10):1749-1754.
12. Fagenholz PJ, Castillo CF, Harris NS, Pelletier AJ, Camargo Jr CA,US Emergency Department Acute Pancreatitis Severity StudyGroup. Increasing United States hospital admissions for acutepancreatitis, 1988-2003. Ann Epidemiol. 2007;17(7):491-497.
13. Marra F, Renzulli M, Zerboni G. Acute pancreatitis:Multidisciplinary management and emerging therapies. World JGastroenterol. 2019;25(32):4163-4171.
14. Tenner S, Sica G, Hughes M, Noordhoek E. Relationshipof necrosis to organ failure in severe acute pancreatitis.Gastroenterology. 2003;124(4):A219.
15. Johnson CD, Abu-Hilal M, Williamson RC. A radiologicalscoring system for severity of acute pancreatitis. Pancreas.2004;29(4):301-312.
16. De Bernardinis M, Violi V, Roncoroni L, et al. Contribution ofimaging and fine needle aspiration cytology to the diagnosis ofchronic pancreatitis: a study in 65 consecutive patients. Dig LiverDis. 2003;35(11):833-839.
17. Petrov MS, van Santvoort HC, Besselink MG, van der HeijdenGJ, Windsor JA, Gooszen HG. Early endoscopic retrogradecholangiopancreatography versus conservative management inacute biliary pancreatitis without cholangitis: a meta-analysis ofrandomized trials. Ann Surg. 2010;251(4):656-664.,
18. Erdogan MÖ, Hokenek NM. How to score acute pancreatitis inthe emergency setting: five systems against ED-SAS. Signa Vitae.2021;1(8).
19. Hökenek UD, Aydıner Ö, Kart JS, Arslan G, Saracoglu KT.Evaluation of the effect of pancreatic volume on mortality inpatients with acute pancreatitis. Am J Emerg Med. 2023;63:38-43.
20. Ibrahim A, Bayramoglu B, Hokenek NM, Tekyol D. Lactateclearance during the first 2 hours after hospital admission: auseful biomarker for predicting 30-day mortality in patients withdiabetic ketoacidosis. Int J Clin Pract. 2021;75(7):e14204.
21. Hokenek NM, Seyhan AU, Erdoğan MÖ, Tekyol D, YılmazY, Korkut S. Evaluation of blood gas analysis as a mortalitypredictor. South Clin Ist Euras. 2019;30(3):228-231.
Volume 4, Issue 6, 2023
Page : 637-641
_Footer