CT EVALUATION OF ACUTE PANCREATITIS AND ITS COMPLICATIONS USING MODIFIED CTSEVERITY INDEX

Objectives 1: To grade the CT findings of patients with acute pancreatitis according to MCTSI 2. To correlate the grading systems with patient outcome in terms of a. Organ failure b. Mortality c. Duration of hospital stay 3. To determine sensitivity, specificity and positive predictive value of MCTSI in predicting the above mentioned complications. Materials and Methods:This study was conducted in the Department of Radio-diagnosis, Mysore medical college and research institute, Mysore from November 2016 to April 2018. The study comprised of a total of 50 patients. Of 50 patients diagnosed with acute pancreatitis who underwent contrast- enhanced MDCT within 3 days of the onset of symptoms during the study period were included in the study. The severity of the pancreatitis was scored using modified CT severity indexes. Patient clinical outcome was scored using parameters such as: mean duration of hospital stay, the need for surgical intervention, occurrences of infection, end organ failure and death. For the modified CT severity indexes, the correlation between the severity of pancreatitis and patient outcome was estimated using the percentage, frequency charts, and chi-square test. Results: This was a prospective study of 50 cases of clinically diagnosed acute pancreatitis and confirmed by serum amylase and lipase levels. Modified CT severity index grading was done after contrast enhanced CT of abdomen and pelvis in all patients. Correlation of modified CT severity index grades was done with patient outcome taking local and systemic complications, duration of hospital stay. The age group of patients was 15 to 66 years with maximum patients (36%) between 26 and 30 years. 86% of patients were male. Male to female ratio was 8.6: 1.4 with male preponderance. Chronic alcohol abuse was the most common cause of pancreatitis (76%), second was gallstones (16%) and others (8%) All patients presented with pain abdomen. 92% had vomiting, 30% patients had fever and 10% of patients had jaundice at the time of presentation. Amylase was elevated in 86% patients. Lipase was elevated in 90% patients. 86% patients had features of pancreatitis on ultrasound and in 14% ultrasound was normal. Pancreatic inflammation was seen in 100% of patients. 30% patients had no evidence of pancreatic necrosis on CT scan. 54% of patients had less than 30% necrosis and only 16% had more than 30% necrosis. 48% patients had no evidence of extrapancreaticComplications. 52%patients had one or more extra pancreatic complications. According to Modified CT Severity Index, 6% patients had mild, 70% patients had moderate and 24% had severe pancreatitis. Duration of hospital stay ranged from 3 to 25 days with mean duration of 9.5 days. Mortality rate was 0%. 38% patients are considered to have end organ failure. Hepatic failure is the most common system failure seen in 22% patients. 36% patients had evidence of systemic infection. 10% patients required surgical interventions. Conclusion: There was highly significant correlation between the MCTSI score and the prediction of end organ failure, systemic infection and duration of hospital stay than CTSI score. MCTSI is a very useful tool for the screening of patients with acute pancreatitis for the classification of severity accurately and to predict the clinical outcome when used before three days of symptom onset. Key words: Computed Tomography Modified CT Severity Index Acute pancreatitis pancreatic necrosis Patient outcome.