Cucuteanu B, Negru D, Gavrilescu O, Popa IV, Floria M, Mihai C, Cijevschi Prelipcean C, Dranga M. Extrapancreatic necrosis volume: A new tool in acute pancreatitis severity assessment? World J Clin Cases 2021; 9(31): 9395-9405 [PMID: 34877275 DOI: 10.12998/wjcc.v9.i31.9395]
Corresponding Author of This Article
Cătălina Mihai, MD, PhD, Associate Professor, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, S University Street 16, Iaşi City 700115, Romania. catalinamihai@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Bogdan Cucuteanu, Dragoş Negru, Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
Otilia Gavrilescu, Cătălina Mihai, Cristina Cijevschi Prelipcean, Mihaela Dranga, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
Iolanda Valentina Popa, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City 700115, Romania
Mariana Floria, Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City 700115, Romania
Author contributions: Dranga M and Cucuteanu B designed and performed the research, and wrote the paper; Dranga M, Popa IV, and Mihai C designed the research, supervised the report, and contributed to the analysis; Gavrilescu O, Floria M, and Mihai C provided clinical advice; Cijevschi Prelipcean C, Negru D, and Mihai C supervised the report.
Institutional review board statement: This study was approved by the Ethics Committee of the “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City, Romania (No. 65/6.04.2021).
Informed consent statement: All of the patients were informed about the study and provided signed informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicting interests to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cătălina Mihai, MD, PhD, Associate Professor, Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, S University Street 16, Iaşi City 700115, Romania. catalinamihai@yahoo.com
Received: April 7, 2021 Peer-review started: April 7, 2021 First decision: June 27, 2021 Revised: July 16, 2021 Accepted: September 3, 2021 Article in press: September 3, 2021 Published online: November 6, 2021 Processing time: 204 Days and 19.9 Hours
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.
Core Tip: This retrospective study evaluated the role of extrapancreatic necrosis volume in the evaluation of acute pancreatitis. The patients were evaluated by established computed tomography scores, the computed tomography severity index (CTSI), and the modified CTSI, as well as a new method using the extrapancreatic necrosis volume. Although all the imaging scores had a strong correlation with the severity of acute pancreatitis, the extrapancreatic necrosis volume had the best diagnostic accuracy for the severe form.
