THE DIAGNOSTIC ACCURACY OF NUMERICAL COMPUTED TOMOGRAPHY SEVERITY INDEX AND RANSON SCORE IN PREDICTING SEVERE ACUTE PANCREATITIS

Main Article Content

Rahmat Ullah Shah
Sadia Shah
Shabir Ahmad

Abstract

 


Objective: To determine the diagnostic accuracy of numerical CT severity index (CTSI) and Ranson score in pre­dicting severe Acute Pancreatitis (AP) keeping organ failure as the gold standard.


Methodology: This descriptive cross-sectional study was carried out in the Department of Surgery, Medical Teaching Institute, Lady Reading Hospital Peshawar, from November 2020 to May 2021 on 238 patients with acute pancreatitis. All patients were subjected to the prediction of Severe Acute Pancreatitis (SAP)/organ failure on CTSI and Ranson criteria.


Results: The mean age of the participants was 30.7+7.6 years. There were 54.2% male and 45.8% female as per gender distribution. The mean duration of AP at presentation was 3.8 +1.8 days. Prediction of SAP in terms of organ failure was predicted in 55.9% of patients on Ranson criteria and 59.2% of patients on CTSI. The sensi­tivity of Ranson criteria was 37.5% and specificity of 25.4% with a Positive Predictive Value (PPV) of 33.8% and a Negative Predictive Value (NPV) of 28.5%. The sensitivity of CTSI was 88.9% and specificity 71.1% with PPV of 75.9% & NPV of 86.6%.


Conclusion: CTSI is a highly sensitive and specific tool for predicting the severity of acute pancreatitis when compared to the Ranson criteria in patients presenting with acute pancreatitis.

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1.
Shah RU, Shah S, Ahmad S. THE DIAGNOSTIC ACCURACY OF NUMERICAL COMPUTED TOMOGRAPHY SEVERITY INDEX AND RANSON SCORE IN PREDICTING SEVERE ACUTE PANCREATITIS. J Postgrad Med Inst [Internet]. 2022 Jun. 30 [cited 2024 Nov. 23];36(2):74-8. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/2940
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References

Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirk¬patrick AW, et al. 2019 WSES guide¬lines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14(1):1-20. DOI:10.1186/ s13017-019-0247-0.

Garber A, Frakes C, Arora Z, Chahal P. Mechanisms and management of acute pancreatitis. Gastroenterol Res Pract. 2018;2018:6218798. DOI:10.1155/2 018/6218798.

Mukherjee D, Bhakta S, Lahiry S, Sinha R. Demographic profile of Acute Pancreatitis in Eastern India: A Single Centre Experience. Asian J Med Sci. 2017:6;8(6):24-9. DOI:0.3126/ajms. v8i6.18282.

Negi N, Mokta J, Sharma B, Sharma R, Jhobta A, Bodh V, et al. Clinical profile and outcome of acute pancreatitis: A hospital-based prospective observa¬tional study in Subhimalayan state. J Assoc Physicians India. 2018;66(3):22- 4.

Krishna SG, Kamboj AK, Hart PA, Hin¬ton A, Conwell DL. The changing epi¬demiology of acute pancreatitis hospi¬talizations: a decade of trends and the impact of chronic pancreatitis. Pancre¬as. 2017;46(4):482-8. DOI:10.1097/ MPA.0000000000000783.

Paul J. Recent Advances in Diag¬nosis and Severity Assessment of Acute Pancreatitis. Prague Med Rep. 2020;121(2):65-86. DOI: 10.14712/23362936.2020.6.

Van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut. 2017;66(11):2024-32. DOI: 10.1136/gutjnl-2016-313595.

Banks PA, Freeman ML. Practice guide¬lines in acute pancreatitis. Am J Gastro¬enterol. 2006;101(10):2379-400.

Ahmed Ali U, Issa Y, Hagenaars JC, Bakker OJ, Van Goor H, Nieuwenhujis VB, et al. Risk of Recurrent Pancreatitis and progression to chronic pancreati¬tis after a first episode of acute pan¬creatitis. Clin Gastroenterol Hepatol. 2016;14(5):738-46. DOI: 10.1016/j. cgh.2015.12.040.

Hamada S, Masamune A, Shimosegawa T. Transition of early-phase treatment for acute pancreatitis: An analysis of na¬tionwide epidemiological survey. World J Gastroenterol. 2017;23(16):2826-31. DOI: 10.3748/wjg.v23.i16.2826.

Stigliano S, Sternby H, de Madaria E, Capurso G, Petrov MS. Early manage¬ment of acute pancreatitis: a review of the best evidence. Dig Liver Dis. 2017;49(6):585-94. DOI: 10.1016/j. dld.2017.01.168.

Hamada S, Masamune A, Shimosegawa T. Management of acute pancreatitis in Japan: analysis of nationwide epidemi¬ological survey. World J Gastroenterol. 2016;22(28):6335-44. DOI: 10.3748/ wjg.v22.i28.6335.

Yu P, Wang S, Qiu Z, Bai B, Zhao Z, Hao Y, et al. Efficacy of resistin and leptin in predicting persistent organ failure in patients with acute pancre¬atitis. Pancreatology. 2016;16(6):952- 7. DOI:10.1016/j.pan.2016.09.002.

Valverde-Lopez F, Matas-Cobos AM, Alegria-Motte C, Jimenez-Rosales R, Ubeda-Munoz M, Redondo-Cerezo E. BISAP, RANSON, lactate and other bio¬markers in prediction of severe acute pancreatitis in a European cohort. J Gas¬troenterol Hepatol. 2017;32(9):1649- 56. DOI: 10.1111/jgh.13763.

Gurusamy KS, Debray TPA, Rompiane¬si G. Prognostic models for predicting the severity and mortality in people with acute pancreatitis. Cochrane Da¬tabase Syst Rev. 2018;2018(5):1-14 DOI:10.1002/14651858.CD013026.

Cho J, Kim TN, Chung HH, Kim KH. Com¬parison of scoring systems in predicting the severity of acute pancreatitis. World J Gastroenterol. 2015;21(8):2387-94. DOI: 10.3748/wjg.v21.i8.2387.

Simchuk EJ, Traverso LW, Nukui Y, Kozarek RA. Computed tomography se¬verity index is a predictor of outcomes for severe pancreatitis. Am J Surg. 2000;179(5):352-5.

Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gas-troenterology.2019;156(7):2008-23. DOI:10.1053/j.gastro.2018.12.041.

Gloor B, Müller CA, Worni M, Mar¬tignoni ME, Uhl W, Büchler MW. Late mortality in patients with se¬vere acute pancreatitis. Br J Surg Society. 2001;88(7):975-9. DOI: 10.1046/j.0007-1323.2001.01813.x.

Working Group IAP/APA Acute Pan¬creatitis Guidelines. IAP/APA ev¬idence based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4):1 15. DOI:10.1016/j.pan.2013.07.063.

Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pan¬creatitis. Hepatobiliary Pancreat Dis Int. 2006;5(2):294-9.

Taylor SL, Morgan DL, Denson KD, Lane MM, L. Pennington R. A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple or¬gan system score in predicting patient outcome in pancreatitis, Am J Surg. 2005;189(2):219-22. DOI: 10.1016/j. amjsurg.2004.11.010.

Yadav J, Yadav SK, Kumar S, Baxla RG, Sinha DK, Bodra P, et al. Predicting mor¬bidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index. Gastro¬enterol Rep. 2016;4(3):216-20. DOI: 10.1093/gastro/gov009.

Cho JH, Kim TN, Chung HH, Kim KH. Comparison of scoring systems in pre¬dicting the severity of acute pancreatitis. World J Gastroetrol. 2015;21(8):2387. DOI:10.3748/wjg.v21.i8.2387.

Sharma V, Rana SS, Sharma RK, Gup¬ta R, Bhasin DK. Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Gastroenterol Rep (Oxf) 2015;3:144-7. DOI: 10.1093/gastro/ gou067.

Khanna AK, Meher S, Prakash S, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pan¬creatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013:367581. DOI:10.1155/2013/367581.

Sahu B, Abbey P, Anand R, Kumar A, Tomer S, Malik. Severity assessment of acute pancreatitis using CT severity index and modified CT severity index: Correlation with clinical outcomes and severity grading as per the revised At¬lanta classification. Indian J Radiol Im¬aging. 27(2):152-60. DOI: 10.4103/ijri. IJRI_300_16.

Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, et al. Comparitive evaluation of modified CT severity index and CT severity index in assessing se¬verity of acute pancreatitis. AJR Am J Roentgenol. 2011;197(2):386-92. DOI: 10.2214/AJR.09.4025.

29. Sharma V, Rana SS, Sharma RK, Kang M, Gupta R, Bhasin DK. A study of ra¬diological scoring system evaluating extrapancreatic inflammation with conventional radiological and clini¬cal scores in predicting outcomes in acute pancreatitis. Ann Gastroenterol. 2015;28:399-404.