The role of extrapancreatic necrotic tissue volume in determining the prognosis of acute pancreatitis in early stage

The Role of Extrapancreatic Necrotic Tissue Volume in Determining the Prognosis of Acute Pancreatitis in Early Stage Acute pancreatitis (AP) is a disease with broad clinical spectrum.70-80% of patients with acute pancreatitis have a mild form, the disease is self-limiting and the mortality is very low. In severe acute pancreatitis is presented with persistent organ failure lasting more than 48 hours and mortality is approximately 20-30%. The aim of this study was to investigate the safety and predictive value of extrapancreatic necrotic tissue volume measurement in early CT images (2-6 days) in terms of local or systemic complications with transient or persistent organ failure due to pancreatitis, in patients who diagnosed acute pancreatitis with clinic and radiologic findings. In our retrospective study, abdominal CT's of adult patients who diagnosed acute pancreatitis with 'Acute Pancreatitis Revised Atlanta Classification' in the Akdeniz University Medical Faculty Hospital between May 2015 and May 2018, were examined. The relation between the extrapancreatic necrosis volume and some clinical parameters such as CRP value, organ failure, infection, surgical requirement or percutaneous intervention, hospital stay and/or death; and some imaging parameters such as CTSI and MCTSI scoring systems were investigated. The ROC curve was used to estimate the optimal threshold for predicting clinical prognosis. A total of 99 patients with AP diagnosis were included to the study. 37 of the 99 patients were female (37,4%), 62 were male (62,2%) and the mean age was 51,5. In both groups, AP was most commonly associated with biliary pathologies. 3 patients were diagnosed with multiple organ dysfunction syndrome (MODS), 1 patient was diagnosed with acute respiratory distress syndrome (ARDS), 1 patient was diagnosed with acute respiratory distress syndrome (ARDS) and acute renal injury (longer than 48 hours) and 2 patients were diagnosed with acute renal injury (longer than 48 hours). 4 patients were died due to organ failure and sepsis that associated with acute pancreatitis. 16 patients underwent percutaneous 65 intervention and/or surgical intervention. The severity of the acute pancreatitis according to CT severity index, was determined as mild in 63, moderate in 22, and severe in 12 patients. The severity of the acute pancreatitis according to modified CT severity index, was determined as mild in 20, moderate in 57 and severe in 20 of the 97 patients. Extraparenchymal complications (pleural effusion, peritoneal fluid, venous thrombosis) were observed in 50 of 99 patients. The mean extrapancreatic necrosis volume was 246 mL. We found a moderate correlation between extrapancreatic necrosis volume and the length of the hospital stay (p=0,0001) and CRP value (48-72. hour) (p=0,0001), significant correlation between extrapancreatic necrosis volume and CTSI (p=0,0001), MCTSI (p=0,0001), WBC count (p=0,0001). Increased extrapancreatic necrosis volume was associated with the occurrence of infection (p=0,0001), organ failure (p=0,001) and death (p=0,006). Extrapancreatic necrosis volume demonstrated the highest AUC of all the scoring systems for organ failure. Extrapancreatic necrosis volume demonstrated the second highest AUC of all the scoring systems for infection. MCTSI demonstrated the highest AUC of all the scoring systems for infection. In conclusion, when the extrapancreatic necrotic tissue volume compared with imaging (Balthazar score, CTSI and MCTSI) and laboratory (48-72. hour CRP value) based scoring systems, it showed better results for prediction of organ failure and infection. This findings are promising for the future. However, there are not enough studies on this subject. Prospective studies with more patients are needed.