Correlation between the Predictive Accuracy of Computed Tomography Severity Index and Clinical Metrics in Acute Pancreatitis at a Tertiary Care Hospital Lahore
Computed Tomography Severity Index and Acute Pancreatitis
DOI:
https://doi.org/10.54393/pjhs.v5i08.1997Keywords:
Acute Pancreatitis, Computed Tomography Severity Index, Predictive Accuracy, Curve AnalysisAbstract
Acute pancreatitis was a common clinical emergency and presents with a vast spectrum of severity and clinical outcomes. The Computed Tomography Severity Index (CTSI) was widely used to evaluate extent of pancreatic inflammation and necrosis. Objective: To compare the CTSI with the clinical severity of acute Pancreatitis in local settings. Methods: It was a retrospective cohort study done on 136 cases diagnosed with acute pancreatitis between 2017 to 2023 at Lahore General Hospital, Lahore, Pakistan. Patients received contrast-based Computed Tomography (CT) within 30 days of onset. CTSI scores were independently assessed by two experienced radiologists. Clinical severity was categorized as mild, moderate and severe pancreatitis. Statistical analysis was done with SPSS 26.0 which involved descriptive, correlational statistics, sensitivity and specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), predictive Accuracy along with ROC curve analysis and Cohen’s kappa statistic. Results: The patients were 74.3% males and had a median age of 51 years. CTSI demonstrated 79.37% sensitivity, 83.56% specificity, 80.65% PPV and 82.43% NPV in determining clinical severity as mild, moderate and severe with a predictive accuracy of 81.62%. Cohen’s kappa of 0.72 reflected substantial agreements between the CTSI and clinical severity assessment. Under the ROC Curve (AUC) the area was 0.87, showing an excellent diagnostic performance. Conclusion: CTSI provides a moderate to fair agreement with clinical severity assessments in acute pancreatitis. It effectively differentiates between mild, moderate and severe cases, supporting its assessment and management.
References
Jaber S, Garnier M, Asehnoune K, Bounes F, Buscail L, Chevaux JB et al. Guidelines for the management of patients with severe acute pancreatitis, 2021. Anaesthesia Critical Care & Pain Medicine. 2022 Jun; 41(3): 101060. doi: 10.1016/j.accpm.2022.101060. DOI: https://doi.org/10.1016/j.accpm.2022.101060
Chatterjee R, Parab N, Sajjan B, Nagar VS. Comparison of acute physiology and chronic health evaluation II, modified computed tomography severity index, and bedside index for severity in acute pancreatitis score in predicting the severity of acute pancreatitis. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2020 Feb; 24(2): 99. doi: 10.5005/jp-journals-10071-23343. DOI: https://doi.org/10.5005/jp-journals-10071-23343
Uludağ SS, Güreş N, Şirolu S, Aşkar A, Şanlı AN, Zengin AK et al. Investigating the correlation between severe acute pancreatitis and pancreatic necrosis with some serum parameters. Turkish Journal of Trauma & Emergency Surgery. 2022 Nov; 28(11): 1609. doi: 10.14744/tjtes.2021.96782. DOI: https://doi.org/10.14744/tjtes.2021.96782
Shaukat R, Mansoor A, Arooj S, Imran Z, Masood M, Asghar A. Diagnostic Accuracy of CT Scan in Necrotizing Pancreatitis Taking Surgical findings as Gold Standard. Esculapio – JSIMS. 2022 Dec. [Last cited: 10th Sep 2024]. Available at: https://esculapio.pk/journal/index.php/journal-files/article/view/129.
Han X, Hu MN, Ji P, Liu YF. Construction and alidation of a severity prediction model for acute pancreatitis based on CT severity index: A retrospective case-control study. Plos one. 2024 May; 19(5): e0303684. doi: 10.1371/journal.pone.0303684. DOI: https://doi.org/10.1371/journal.pone.0303684
Debbarma A, Biswas R, Saha T, Debbarma S. Laboratory parameters of patients with acute pancreatitis and their correlation with severity index at tmc and dr bram teaching hospital. European Journal of Cardiovascular Medicine. 2024 Jul; 14: 303-9.
Hu JX, Zhao CF, Wang SL, Tu XY, Huang WB, Chen JN et al. Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence. World Journal of Gastroenterology. 2023 Oct; 29(37): 5268. doi: 10.3748/wjg.v29.i37.5268. DOI: https://doi.org/10.3748/wjg.v29.i37.5268
Prasad NL, Rakshit EP, Asad M. A study on the concordance of serum c-reactive protein and serum lactate dehydrogenase with CT severity index in assessing the severity of acute pancreatitis. European Journal of Cardiovascular Medicine. 2024 Jan; 14(1).
Apisarnthanarak P, Boonsri P, Suvannarerg V, Chaiyasoot W, Pongprasobchai S, Apisarnthanarak A. Comparison of CT Severity Index and Modified CT Severity Index in the Clinical Severity Assessment of Acute Pancreatitis. Journal of Health Science and Medical Research. 2022 May; 40(4): 425-35. doi: 10.31584/jhsmr.2021854. DOI: https://doi.org/10.31584/jhsmr.2021854
Mohey N and Hassan TA. Correlation between modified CT severity index and retroperitoneal extension using the interfascial planes in the grading of clinically suspected acute severe pancreatitis. Egyptian Journal of Radiology and Nuclear Medicine. 2020 Dec; 51: 1-0. doi: 10.1186/s43055-020-00206-1. DOI: https://doi.org/10.1186/s43055-020-00206-1
Mikó Á, Kaposi A, Schnabel K, Seidl D, Tory K. Identification of incompletely penetrant variants and interallelic interactions in autosomal recessive disorders by a population‐genetic approach. Human Mutation. 2021 Nov; 42(11): 1473-87. doi: 10.1002/humu.24273. DOI: https://doi.org/10.1002/humu.24273
Cucuteanu B, Negru D, Gavrilescu O, Popa IV, Floria M, Mihai C et al. Extrapancreatic necrosis volume: A new tool in acute pancreatitis severity assessment?. World Journal of Clinical Cases. 2021 Nov; 9(31): 9395. doi: 10.12998/wjcc.v9.i31.9395. DOI: https://doi.org/10.12998/wjcc.v9.i31.9395
Colvin SD, Smith EN, Morgan DE, Porter KK. Acute pancreatitis: an update on the revised Atlanta classification. Abdominal Radiology. 2020 May; 45: 1222-31. doi: 10.1007/s00261-019-02214-w. DOI: https://doi.org/10.1007/s00261-019-02214-w
Alberti P, Pando E, Mata R, Vidal L, Roson N, Mast R et al. Evaluation of the modified computed tomography severity index (MCTSI) and computed tomography severity index (CTSI) in predicting severity and clinical outcomes in acute pancreatitis. Journal of Digestive Diseases. 2021 Jan; 22(1): 41-8. doi: 10.1111/1751-2980.12961. DOI: https://doi.org/10.1111/1751-2980.12961
Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C et al. Acute pancreatitis: diagnosis and treatment. Drugs. 2022 Aug; 82(12): 1251-76. doi: 10.1007/s40265-022-01766-4. DOI: https://doi.org/10.1007/s40265-022-01766-4
Nagarchi AR, Babu M, Saad S. Computed tomography severity index and serum CRP concentration for predicting the severity of acute pancreatitis. International Surgery Journal. 2021 Feb; 8(3): 895-8. doi: 10.18203/2349-2902.isj20210923. DOI: https://doi.org/10.18203/2349-2902.isj20210923
Dal-Ré R. Waivers of informed consent in research with competent participants and the Declaration of Helsinki. European Journal of Clinical Pharmacology. 2023 Apr; 79(4): 575-8. doi: 10.1007/s00228-023-03472-w. DOI: https://doi.org/10.1007/s00228-023-03472-w
Iqbal M, Malik M, Perveen S. Morbidity and mortality in acute pancreatitis. Journal of Surgery Pakistan (International). 2015 Oct; 20: 4.
Shah MJ, Afzal M, Khan MA, Ullah A. Accuracy of CTSI in Predicting Severity in Acute Pancreatitis Keeping Ranson Score as Gold Standard. Pakistan Journal of Medical & Health Sciences. 2022; 16(12): 120-. doi: 10.53350/pjmhs20221612120. DOI: https://doi.org/10.53350/pjmhs20221612120
Tahir H, Rahman S, Habib Z, Khan Y, Shehzad S. Comparison of the accuracy of modified CT Severity Index Score and neutrophil-to-lymphocyte ratio in assessing the severity of acute pancreatitis. Cureus. 2021 Aug; 13(8): e17020. doi: 10.7759/cureus.17020. DOI: https://doi.org/10.7759/cureus.17020
Mathai MJ and Shetty V. Analysis of the Accuracy of the Modified CT Severity Index in Predicting Clinical Outcomes in Acute Pancreatitis: A Cross-Sectional Study. Cureus. 2024 Mar; 16(3): e56123. doi: 10.7759/cureus.56123. DOI: https://doi.org/10.7759/cureus.56123
Parmar G, Noronha GP, Poornima V. Comparative analysis of computed tomography severity indices in predicting the severity and clinical outcome in patients with acute pancreatitis. F1000Research. 2024 Jul; 11: 1272. doi: 10.12688/f1000research.125896.2. DOI: https://doi.org/10.12688/f1000research.125896.2
Olpin JD and Griffith A. Imaging of Acute Pancreatitis According to the Revised Atlanta Classification. Current Radiology Reports. 2022 Nov; 10(11): 140-9. doi: 10.1007/s40134-022-00402-z. DOI: https://doi.org/10.1007/s40134-022-00402-z
Balthazar JA and Chehter EZ. Acute pancreatitis and COVID-19: a new target for infection?. Einstein (Sao Paulo). 2022 Feb; 20: eRW6667. doi: 10.31744/einstein_journal/2022RW6667. DOI: https://doi.org/10.31744/einstein_journal/2022RW6667
Jiang X, Shi JY, Wang XY, Hu Y, Cui YF. The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study. Military Medical Research. 2020 Dec; 7: 1-1. doi: 10.1186/s40779-020-00265-5. DOI: https://doi.org/10.1186/s40779-020-00265-5
Cho IR, Do MY, Han SY, Jang SI, Cho JH. Comparison of interleukin-6, C-reactive protein, procalcitonin, and the computed tomography severity index for early prediction of severity of acute pancreatitis. Gut and liver. 2023 Jul; 17(4): 629. doi: 10.5009/gnl220356. DOI: https://doi.org/10.5009/gnl220356
Kim K, Kim SB. Predictors of Severity of Acute Pancreatitis. Gut and Liver. 2023 Jul; 17(4): 493. doi: 10.5009/gnl230235. DOI: https://doi.org/10.5009/gnl230235
Yang Q, Gao Y, Li Z, Zheng J, Fu H, Ma Y. Analysis of Risk Factors for Severe Acute Pancreatitis in the Early Period (< 24 h) After Admission. The Journal of Emergency Medicine. 2024 Jul; 67(1): e1-9. doi: 10.1016/j.jemermed.2024.02.011. DOI: https://doi.org/10.1016/j.jemermed.2024.02.011
Zhang J, Du JJ, Tang W, Zhang XY, Jiang R, Yang GQ et al. CT characteristics of recurrent acute pancreatitis and acute pancreatitis in different stages—a retrospective cross-sectional study. Quantitative Imaging in Medicine and Surgery. 2023 Jul; 13(7): 4222. doi: 10.21037/qims-22-1172. DOI: https://doi.org/10.21037/qims-22-1172
Yamamoto T, Horibe M, Sanui M, Sasaki M, Mizobata Y, Esaki M et al. Early detection of necrosis in low-enhanced pancreatic parenchyma using contrast-enhanced computed tomography was a better predictor of clinical outcomes than pancreatic inflammation: A multicentric cohort study of severe acute pancreatitis. Pancreatology. 2024 Jul. doi: 10.1016/j.pan.2024.07.001. DOI: https://doi.org/10.1016/j.pan.2024.07.001
Gupta P, Dawra S, Chandel K, Samanta J, Mandavdhare H, Sharma V et al. Fat-modified computed tomography severity index (CTSI) is a better predictor of severity and outcome in patients with acute pancreatitis compared with modified CTSI. Abdominal Radiology. 2020 May; 45: 1350-8. doi: 10.1007/s00261-020-02473-y. DOI: https://doi.org/10.1007/s00261-020-02473-y
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
