Pleural effusion volume in patients with acute pancreatitis: a retrospective study from three acute pancreatitis centers

Abstract

Objective: To assess the value of pleural effusion volume (PEV) quantified on chest computed tomography (CT) in patients with early stage acute pancreatitis (AP).

Methods: Data of PEV, and C-reactive protein (CRP) levels as well as Ranson, bedside index of severity in acute pancreatitis (BISAP), Marshall, acute physiology and chronic health evaluation II (APACHE II), CT severity index (CTSI), and extra-pancreatic inflammation on computed tomography (EPIC) scores in patients with AP were collected. Duration of hospitalization, severity of AP, infection, procedure, intensive care unit (ICU) admission, organ failure, or death were included as the outcome parameters.

Results: In 465 patients, the mean PEV was 98.8 ± 113.2 mL. PEV showed strong and significant correlations with the CRP levels, duration of hospitalization as well as the Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores (p < .05). PEV demonstrated significant accuracy in predicting severity, infection, procedure, ICU admission, organ failure, and death (p < .05).

Conclusion: PEV quantified on chest CT positively associated with the duration of hospitalization, CRP levels, Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores. It can be a reliable radiologic biomarker in predicting severity and clinical outcomes of AP.KEY MESSAGESPleural effusion is a common chest finding in patients with acute pancreatitis.Pleural effusion volume quantified on chest CT examination positively associated with the duration of hospitalization, CRP level, as well as Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scoring systems.Pleural effusion volume can be a reliable radiologic biomarker in the prediction of severity and clinical outcomes of acute pancreatitis.

Keywords: Pleural effusion; acute pancreatitis; computed tomography.

Figure 1.

Flow chart for inclusion and exclusion of patients.

Figure 2.

The measurement of pleural effusion volume with chest CT images.

Figure 3.

Mild interstitial oedematous pancreatitis (IEP) in a 57-year-old female (CRP level of 28 mg/L, Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC of 1, 1, 0, 4, 4, and 3 points, respectively; there was no infection, procedure, ICU admission, organ failure, or death on this patient). Abdominal axial contrast-enhanced CT at the portal phase (A) showed there was a small amount of acute peripancreatic fluid collection (APFC) around the pancreas. Axial chest image CT (B) showed there was a small amount of bilateral pleural effusion.

Figure 4.

Severe necrotizing pancreatitis (combined pancreatic and peripancreatic) in a 42-year-old male (CRP level of 253 mg/L, Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC of 5, 4, 18, 6, 6, and 3 points, respectively; positive for infection and organ failure while no procedure was done, no ICU admission, or death on this patient). Abdominal axial contrast-enhanced CT at the portal phase (A) showed there was a large amount of acute necrotic collection (ANC) around the pancreas. Axial chest image CT (B) showed there was a large amount of left pleural effusion.

Figure 5.

Bar graph shows mean pleural effusion volume in millilitres (error bars = 95% CIs) for each clinical outcome. *p < .0001.

Figure 6.

Receiver operating characteristic curves (ROC) of the pleural effusion volume, C-reactive protein levels and different clinical scoring systems for predicting severe acute pancreatitis (A), infection (B), procedure (C), ICU admission (D), organ failure (E), and death (F).