Abstract
Objectives
The aim of the study is to investigate the CT imaging findings of severe acute pancreatitis (SAP) complicated with acute kidney injury (AKI) and evaluate the correlation between the CT imaging score and the presence of AKI in SAP.
Materials and methods
Contrast-enhanced CT scanning was performed for all 145 patients. Related CT indices such as Balthazar CT grading, CTSI and EPIC scores were calculated. Clinical data, including APACHE II, Ranson scores, serum creatinine levels, urine output, and mortality, were then collected and compared with CT indices.
Results
The EPIC score showed a larger area under the receiver operating characteristic curve than either of the CTSI or Balthazar score. However, the change of APACHE II score, but not EPIC score, was significantly associated with the prognosis of AKI and eventual clinical outcome. In addition, the CT manifestation of fluid encapsulation was a good predictor of recovery from AKI.
Conclusions
Among the CT indices, the EPIC score, which possessed a good correlation with both APACHE II and Ranson scores, provided a better prediction of AKI in SAP patients than CTSI and Balthazar scores. Encapsulation of inflammatory exudates might be used in the future as imaging-based prognostic criteria of recovering from AKI in patients with SAP.
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References
Li H, Qian Z, Liu Z, et al. (2010) Risk factors and outcome of acute renal failure in patients with severe acute pancreatitis. J Crit Care 25(2):225–229
Chiuţu L, Georgescu E, Purcaru F, Nemeş R, Georgescu I (2006) Severity factors of acute renal failure in severe acute pancreatitis. Chirurgia (Bucur) 101(6):609–613
Herrera Gutiérrez ME, Seller Pérez G, de La Rubia De Gracia C, Chaparro Sánchez MJ, Nacle López B (2000) Acute renal failure profile and prognostic value in severe acute pancreatitis. Med Clin (Barc) 115(19):721–725
Kes P, Vucicević Z, Ratković-Gusić I, Fotivec A (1996) Acute renal failure complicating severe acute pancreatitis. Ren Fail 18(4):621–628
Louke JD, Jan JDW, Philippe OD (2010) Acute pancreatitis: radiologic scores in predicting severity and outcome. Abdom Imaging 35:349–361
Swaroop VS, Chari ST, Clain JE (2004) Severe acute pancreatitis. JAMA 291(23):2865–2868
Balthazar EJ, Ranson JH, Naidich DP, et al. (1985) Acute pancreatitis: prognostic value of CT. Radiology 156:767–772
Balthazar EJ, Robinson DL, Megibow AJ, et al. (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174:331–336
De Waele JJ, Delrue L, Hoste EA, et al. (2007) Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system. Pancreas 34:185–190
Mehta RL, Kellum JA, Shah SV, et al. (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care 11:R31
Brestas PS, Dafni UG (2006) Assessment of the severity of acute pancreatitis. The usefulness of ROC analysis in comparative studies of clinical and imaging prognostic indices. JOP 7:245–246
Muddana V, Whitcomb DC, Khalid A, et al. (2009) Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. Am J Gastroenterol 104:164–170
Shinzeki M, Ueda T, Takeyama Y, et al. (2008) Prediction of early death in severe acute pancreatitis. J Gastroenterol 43:152–158
Famularo G, Minisola G, De Simone C (2006) Acute pancreatitis. N Engl J Med 355:961
Avinash B, Kalyan N, Lakshmi AY, Padmanabhan S, Siva Kumar V (2005) Acute renal failure in acute pancreatitis: role of pancreatic computed tomography severity index (CTSI). Indian J Nephrol 15:14–16
De Bernardinis M, Violi V, Roncoroni L, et al. (1999) Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: a meta-analytic study. Crit Care Med 27:2272–2283
Larvin M, McMahon MJ (1989) APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 2:201–205
Yeung YP, Lam BY, Yip AW (2006) APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int 5:294–299
Kim HC, Yang DM, Kim HJ, et al. (2008) Computed tomography appearances of various complications associated with pancreatic pseudocysts. Acta Radiol 49:727–734
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Zhengyan Li and Ling Zhang contributed equally to this paper.
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Li, Z., Zhang, L., Huang, Z. et al. Correlation analysis of computed tomography imaging score with the presence of acute kidney injury in severe acute pancreatitis. Abdom Imaging 40, 1241–1247 (2015). https://doi.org/10.1007/s00261-014-0289-4
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DOI: https://doi.org/10.1007/s00261-014-0289-4