Acute pancreatitis is a severe disease with unpredictable course and outcomes.
It is especially hard to identify early those patients who will have a fulminant course.
In a prospective observational study, Dr Vriens and colleagues assessed the computed tomography severity index.
The research team established the severity index within 48 hours after admission.
|A computed tomography severity index of 0 to 3 had a 2% mortality rate|
|Journal of the American College of Surgeons|
The team assessed whether the severity index is prognostic for morbidity and mortality.
The team also considered whether the index can predict the necessity for admission to an intensive care unit.
From 1994 to 2002, all patients with first time acute pancreatitis underwent spiral computed tomography with intravenous contrast within 48 hours of admission.
The extent of inflammation and necrosis was assessed to define the computed tomography severity index.
Patients were initially managed in an intensive care unit in a standardized fashion, and complications and mortality were registered in a systematic manner.
The research team reported that 79 patients were admitted with acute pancreatitis.
The researchers found that the overall complication rate was 57%, and mortality was 9%.
In patients with a computed tomography severity index of 0 to 3, these rates were 42% and 2%, respectively.
The team noted that in those with a computed tomography severity index of 4 to 6, the complication and mortality rates were 81% and 19%, respectively.
The researchers observed that in those with a severity index of 7 to 10, the complication and mortality rates were 100% and 33%, respectively.
Outcomes of subsequent computed tomography scans did not alter the initial prognosis.
The research team noted that an early computed tomography severity index correlated well with the incidence of complications.
The researchers also noted that sepsis, mortality, and necessity for intensive care admission was correlated with an early computed tomography severity index.
Dr Vriens' team concluded, “Acute pancreatitis is associated with marked morbidity and mortality.”
“Initial admission to an intensive care unit and standardized conservative treatment are justified for all patients.”
“Early establishment of the computed tomography severity index is an excellent prognostic tool for complications and mortality.”
“Patients with a computed tomography severity index of 0 to 3 can safely be discharged from the intensive care unit.”