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. 2021 Nov 6;9(31):9395-9405.
doi: 10.12998/wjcc.v9.i31.9395.

Extrapancreatic necrosis volume: A new tool in acute pancreatitis severity assessment?

Bogdan Cucuteanu  1 , Dragoş Negru  1 , Otilia Gavrilescu  2 , Iolanda Valentina Popa  3 , Mariana Floria  4 , Cătălina Mihai  5 , Cristina Cijevschi Prelipcean  2 , Mihaela Dranga  2
Affiliations

Extrapancreatic necrosis volume: A new tool in acute pancreatitis severity assessment?

Bogdan Cucuteanu et al. World J Clin Cases. .

Abstract

Background: Many scores have been suggested to assess the severity of acute pancreatitis upon onset. The extrapancreatic necrosis volume is a novel, promising score that appears to be superior to other scores investigated so far.

Aim: To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.

Methods: A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology, St Spiridon Hospital between January 1, 2017 and December 31, 2019 were analyzed retrospectively. Pancreatitis was classified according to the revised Atlanta classification (rAC) as mild, moderate, or severe. Severity was also evaluated by computed tomography and classified according to the computed tomography severity index (CTSI) and the modified CTSI (mCTSI). The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.

Results: The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC (r = 0.926, P < 0.001 and r = 0.950, P < 0.001; r = 0.784, P < 0.001, respectively). The correlation of C-reactive protein with severity was positive but not as strong, and was not significant (r = 0.133, P = 0.154). The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume [area under the curve (AUC) = 0.993; 95% confidence interval (CI): 0.981-1.005], with a 99.5% sensitivity and 99.0% specificity at a cutoff value of 167 mL, followed by the mCTSI 2007 score (AUC = 0.972; 95%CI: 0.946-0.999), with a 98.0% sensitivity and 96.5% specificity, and the CTSI 1990 score (AUC = 0.969; 95%CI: 0.941-0.998), with a 97.0% sensitivity and 95.0% specificity.

Conclusion: Radiological severity scores correlate strongly and positively with disease activity. Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.

Keywords: Acute pancreatitis; Computed tomography index; Extrapancreatic necrosis volume; Modified computed tomography index C-reactive protein; Severity score.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicting interests to disclose.

Figures

Figure 1
Figure 1
Correlation between computed tomography severity index 1990 and revised Atlanta criteria. CTSI: Computed tomography severity index; rAC: Revised Atlanta criteria.
Figure 2
Figure 2
Correlation between modified computed tomography severity index 2007 and revised Atlanta criteria. mCTSI: Modified computed tomography severity index; rAC: Revised Atlanta criteria.
Figure 3
Figure 3
Correlation between extrapancreatic necrosis volume and revised Atlanta criteria. rAC: Revised Atlanta criteria.
Figure 4
Figure 4
Correlation between C-reactive protein and revised Atlanta criteria. CRP: C-reactive protein; rAC: Revised Atlanta criteria.
Figure 5
Figure 5
Correlation between pancreatic necrosis volume and the severity of acute pancreatitis. rAC: Revised Atlanta criteria.
Figure 6
Figure 6
Receiver operating characteristic curve analysis. Computed tomography severity index (1990) and modified computed tomography severity index (2007) scores, necrosis volume, and C-reactive protein in determining the severity of pancreatitis. CTSI: Computed tomography severity index; mCTSI: Modified computed tomography severity index; CRP: C-reactive protein.
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