Evaluation of extrapancreatic inflammation on abdominal computed tomography as an early predictor of organ failure in acute pancreatitis as defined by the revised Atlanta classification

Abstract

The aim of the study was to determine whether extrapancreatic inflammation on computed tomography (EPIC) is helpful in predicting organ failure in the early phase of acute pancreatitis (AP) as defined by the 2012 revised Atlanta classification.Patients (n = 208) who underwent abdominal computed tomography (CT) within 24 hours after AP onset and admission were retrospectively identified. Each patient's EPIC score, Balthazar score, bedside index of severity in acute pancreatitis (BISAP), and systemic inflammatory response syndrome (SIRS) score were obtained. Primary endpoints were organ failure occurrence and death. Scores were evaluated by receiver operator characteristic (ROC) curve and area under the curve (AUC) analysis.Median age was 45 years (range: 18-83 years). Forty-seven patients (22.6%) developed organ failure, and 5 patients (2.4%) developed infection and underwent surgery. Two patients died. The median EPIC score was 2 (range: 0-7). EPIC score accuracy (AUC = 0.724) in predicting organ failure was similar to that of BISAP (0.773) and SIRS (0.801) scores, whereas Balthazar scoring was not significant (P = .293). An EPIC score of 3 or greater had a sensitivity and specificity of 80.65% and 63.16%, respectively. EPIC scores correlated moderately with organ failure severity (Spearman r = 0.321) and number of failed organs (r = 0.343).The EPIC scoring system can be useful in predicting the occurrence of organ failure, but it does not differentiate severity and number of failed organs in early phase AP.

Figure 1

Flow diagram showing the cohort selection process and final diagnoses. AP = acute pancreatitis, MRI = magnetic resonance imaging.

Figure 2

ROC curves of scoring systems for predicting organ failure in AP. The ROC curves show the AUC for the EPIC, Balthazar, BISAP, and SIRS scoring systems. AP = acute pancreatitis, BISAP = bedside index of severity in acute pancreatitis, EPIC = extrapancreatic inflammation on computed tomography, ROC = receiver operator characteristic, SIRS = systemic inflammatory response syndrome.

Figure 3

Transverse unenhanced abdominal CT scans of a 41-year-old man with AP who was discharged from the hospital 6 days after admission and had an EPIC score of 1. (A) Pleural effusions not present. (B) Right retroperitoneal inflammation. (C and D) Mesenteric inflammation and pelvic ascites not present. AP = acute pancreatitis, CT = computed tomography, EPIC = extrapancreatic inflammation on computed tomography.

Figure 4

Transverse unenhanced abdominal CT scans of a 51-year-old man with AP who was discharged from the hospital 48 days after admission and had an EPIC score of 6. (A) Unilateral pleural effusions. (B) Bilateral retroperitoneal inflammation and mesenteric inflammation. (C and D) Ascites in perisplenic, perihepatic, interloop, and pelvic locations. AP = acute pancreatitis, EPIC = extrapancreatic inflammation on computed tomography.