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Background: Acute pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera. Prediction of severity is an essential step in the management of acute pancreatitis. 50% of mortality can be reduced to 8% by its early recognition. PANC-3 score is widely available test that can be performed quickly, easy to measure with high accuracy in predicting acute pancreatitis.Methods: This cross-sectional study was conducted in the department of general surgery, VMMC and Safdarjung Hospital over 50 patients admitted with acute pancreatitis. After making the clinical diagnosis, PANC -3 score, modified ATLANTA score, APACHE II were done. CRP and CTSI (computed tomography sensitivity index) were calculated and correlated.Results: Mean age was 44.74 years and most common cause was biliary tract pathology. Mortality observed in 5 patients, 11 patients had severe disease. Sensitivity of PANC- 3 was 81.82%, specificity -92.31% with 75% PPV and 94.7% NPV.Conclusions: PANC-3 can be used to predict the severity of pancreatitis as efficiently as Modified ATLANTA classification/APACHE II. It uses only three criteria which are easily done, and available in the basic health care setup. Its interpretation does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.
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Introduction: CECT is very accurate and sensitiveinvestigation in evaluating the severity of acute pancreatitisand the associated complications.With the help of CT, wecan manage the patient of acute pancreatitis by categorisingthem into mild, moderate and severe cases according tomodified CT severity index and predict the clinical outcomeas well. CT mainly detects the associated complication suchas sterile or necrotic fluid collection, pseudocyst fomation,walled off necrosis, pleural effusion, liver cirrhosis mainlyin chronic alcoholic patients vascular complications at earlystage.Aim: To study the role of computed tomography in predictingseverity of acute pancreatitis and its correlation with clinicaloutcome.Material and Methods: The Study was carried out atDepartment of Radio Diagnosis, Krishna Institute of MedicalScience, Karad, Maharashtraamong 46 cases of acutepancreatitis.Result: The mean age of participants in the present study wasobserved to be 35.95 years. Majority were males (39, 84.78%)and 7 were females (15.22%), with male: female ratio of 1:0.18.The majority of the cases (78.29%) were alcoholic while 10cases were non alcoholic. Cases associated with Gall stoneswere21.73% 95.65% cases presented with abdominal pain.Based on Computed Tomography (CT) findings, we found63% patients with acute interstitial edematous pancreatitis and37% patients with acute necrotic pancreatitis among 46 cases.When we evaluated Modified CT Severity index among thestudy cases, we observed that 19.56% cases have mild index,majority (56.52% cases) have moderate index while 23.91%cases have severe index. We also found that majority ofpercentage of cases clinically cured and discharged i.e. 47.82%. 19.56% of the total study subjects reported recurrence ofepisodes of pancreatitis, while 30.43% of the total patientsturned into chronic pancreatitis.Conclusion: Computed tomography can be used to knowthe extent of disease within pancreatic parenchyma andto diagnose associated complications, at early stage.It canassess severity of acute pancreatitis and forecast progress ofpancreatitis.
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Background: All suspected cases of acute pancreatitis should undergo CT scan. It is non invasive and reliable. CT scan is able to give complete picture of acute pancreatitis. The objective of the presentMethods: The present study was hospital based. 60 cases with evidence of acute pancreatitis were included. They were studied for 3 years from June 2015 to May 2018. CT scan was performed in all cases. CT features of the pancreas were noted and described.Results: Acute pancreatitis incidence was four times more in males compared to females i.e. 80% vs. 20%. CT scan showed that pancreatic gland was normal only in 16.7% of the cases. The contour was irregular in 66.7% of the cases. Eight cases showed necrosis. Less than 30% three patients (10%) had grade A acute pancreatitis. 28 cases were showing Phlegmonous changes. In 24 cases it was observed that lesser sac was affected.Conclusions: Authors conclude that for grading and staging of the pancreatitis of acute nature, CT scan is must and is very helpful to the clinicians. CT scan helps not only in precise diagnosis but also in predicting the proper prognosis of the patients who are affected by the pancreatitis of acute in nature.
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Objective To investigate the value of the bedside index for severity in acute pancreatitis (BISAP),Ranson's,APACHE Ⅱ and computed tomography severity index (CTSI) scoring system in evaluating the severity of acute pancreatitis.Methods The clinical data of 385 patients with acute pancreatitis who were admitted to the Zhongnan Hospital of Wuhan University from 2005 to 2011 were retrospectively analyzed.The values of 4 scoring systems including BISAP,Ranson's,APACHE Ⅱ and CTSI in predicting the incidences of severe acute pancreatitis,local complications and death were investigated by Chi-square test and receiver operating characteristic curv e.Odds ratio (OR) was calculated.The differences of areas under the curves (AUC) were analyzed using the Z test.Results The incidences of severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥ 3 were 64.4％ (56/87),16.1％ (14/87) and 8.0％ (7/87),which were significantly higher than 13.4％ (40/298),6.4％ (19/298) and 0.3 ％ (1/298) of patients with BISAP score ≤ 2 (x2 =93.4,8.1,19.7,P ＜ 0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with Ranson's score≥3 were 52.7％ (48/91),22.0％ (20/91) and 7.7％ (7/91),which were significantly higher than 16.3％ (48/294),4.4％ (13/294) and 0.3％ (1/294) of patients with Ranson's score ≤2 (x2 =49.2,27.3,18.5,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with APACHE Ⅱ score ≥ 8 were 46.6％ (27/58),20.7％ (12/58) and 8.6％ (5/58),which were significantly higher than 21.1％ (69/327),6.4％ (21/327) and 0.9％ (3/327) of patients with APACHE Ⅱ score≤7 (x2 =17.0,12.8,14.4,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with CTSI score ≥4 were 51.4％ (19/37),51.4％ (19/37),16.2％ (6/37),which were significantly higher than 22.2％ (77/347),4.0％ (14/347),0.6％ (2/347) of patients with CTSI score≤3 (x2 =15.1,95.3,40.1,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 58％,89％,64％,86％,respectively,and the AUC was 0.848,which were significantly higher than the other 3 systems (Z =2.02,4.22,4.78,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of CTSI were 58％,95％,51％ and 96％,respectively,and the AUC was 0.926,which was significantly higher than the other 3 systems (Z =3.99,3.24,4.06,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 88％,79％,8％ and 100％,respectively,and the AUC was 0.855,with no significant difference compared with the other 3 systems (Z =0.81,0.03,0.14,P ＞ 0.05).Conclusions The accurate rate of BISAP in predicting the severe acute pancreatitis is higher than Ranson's,APACHE Ⅱ and CTSI.The accurate rate of CTSI in predicting the incidence of local complications is higher than the other 3 systems.There is no significant difference of the 4 systems in predicting the mortality.The BISAP scoring system is helpful in early diagnosis of severe acute pancreatitis,and making the individualized treatment plan,thus improving the prognosis of patients.
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Objective To evaluate the value of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in diagnosing severe acute pancreatitis. Methods Sixty-eight patients with suspected diagnosis of severe acute pancreatitis were collected and were scored by BISAP, APACHE Ⅱ , Ranson and CTSI scoring systems, respectively. BISAP scoring system included the blood urea nitrogen, impaired mental status,systemic inflammatory response syndrome, age, and pleural effusion. The diagnosis criteria of severe acute pancreatitis was BISAP ≥ 3 points or APACHE IⅡ ≥ 8 points, Ranson ≥ 3 points, CTSI ≥ 3 points. The diagnostic accuracy of SAP of these scoring systems was calculated. Results Among these 68 cases, 63.2％(43/68) were graded ≥ 3 points in BISAP scoring system;60.3％ (41/68) were marked ≥8 points in APACHE Ⅱ scoring system; 60.3％ (41/68) were scored ≥ 3 points in Ranson scoring system; and 67.6％(46/68) were scored ≥3 points in CTSI scoring system. There was no statistical difference between BISAP scoring system and other three scoring systems in diagnosing severe acute pancreatitis. Conclusions As a new and simple scoring system, BISAP scoring system can be widely used in the diagnosis of severe acute pancreatitis.