Value of computed tomography in assessment of acute pancreatitis severity degree and its correlation with outcomes of the disease


Tomas Tvarijonas1, Gertrūda Rudaitytė 1 , Laima Pileckienė2 , Kristina Žvinienė2

1Lithuanian University of Health Sciences, medical academy, faculty of medicine

2Lithuanian University of Health Sciences hospital, clinic of Radiology




The aim: to assess computed tomography severity indices for pacients, suffering from acute pancreatitis and to determine their correlation with outcomes of the disease.

Methods: this was a retrospective study, in which ,patients with acute pancreatitis, abdominal Computed Tomography  (CT) images and clinical data were studied. Patients were treated in Lithuanian University of Health Sciences, Kaunas Clinics of Surgery, Gastroenterology and Intensive care from 2012-01-01 to 2014-12-31. CT images were evaluated using criteria from Balthazar (CTSI) and Modified CT severity indices (MCTSI). We evaluated the following indicators – sex, age, duration of hospitalization, interventions, organs failure, infection, lethal outcomes. All calculations were performed using SPSS 24.0 for Windows software. P-value less than 0.05 were considered statistically significant.

Results: 180 patients were enrolled in this study – 108 (60%) males and 72 (40%) females. Patients with acute pancreatitis average age was 56.52 year. Average hospitalization time: males – 21.86 d., women – 18.82 d. Hospitalization duration varies from 2 to 187 days. Interventions were performed on 14.4% of the patients: percutaneous drainage – 6.1%, surgery – 8.3%. There were 8.9% lethal outcomes. Most common causes of acute pancreatitis were:  gallbladder stones (33.3%) and alcohol (58.3%). Most common pancreatic extrapancreatic complications were: ascites (51.7%) and pleuritis (43.9%). Organs failure developed for 11.7% of the patients. Having calculated CTSI and MCTSI, there was a statistically significant correlation between severity indices, assessed by both radiologists (rs= 0,4, p<0,05). There was a correlation between severity indices and hospitalization time and the demand for intervention (p<0,05); No statistically significant correlation have been found between infection rate and severity indices (p>0.05), although there was a statistically significant correlation between CTSI severity index and organs failure manifestation as well as lethality (p<0,05).

Conlusions: 1. Assessing acute pancreatitis using CTSI, the highest number of cases were high degree, lowest – medium degree, whereas, assessing by using MCTSI, the highest number of cases were high degree, lowest – low degree. 2. Evaluating by using CTSI and MCTSI there was a statistically significant correlation between both indices severity degrees and hospitalization time,  demand for intervention, also between CTSI and organs failure and lethality. There was no statistically significant correlation between CTSI severity degree and infection rates and MCTSI with organs failure and lethality. 3. Having compared two independent radiologists, with different work experience, assessment congruence, there was a statistically significant average strength assessment congruence.

Keywords: CT, pancreatitis, outcomes.