Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India ??? A Comparative Cross-Sectional Study

Author(s): Jayaprakash Subramani1, Rajesh Prabhu2, Jagadeesapandian Palpandi3

Acute pancreatitis is not uncommon in surgical practice with variable clinical
presentation. Because of its potential notable catastrophic complications, it is
mandatory to assess the severity at the earliest. In recent times, the decision
making in the management is quite difficult due to its complications and
outcome. So, an objective assessment of severity based on clinical and
laboratory scoring verses computed tomography (CT) severity is still debate,
hence the need for study. The purpose of this study was to compare the
efficiency of CT severity index verses APACHE II and Ranson criteria in predicting
the severity of acute pancreatitis.
A total number of 36 consecutive cases of acute pancreatitis who were admitted
between January 2013 and December 2014 in Apollo Specialty Hospitals –
Madurai were included in the study. Written informed consent was obtained from
all study participants.
In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were
females. The sex distribution shows a clear male predominance. Most of the
patients in the present study belonged to the middle age group. Alcohol was the
most common cause accounting for 41.7 % of the cases followed by the billiary
pathology. CT severity index was the superior tool for prediction of the prognosis
and early complications.
When using contrast enhanced computed tomography, it was found that there
was a significant correlation between the development of organ failure and
severity of pancreatitis. The specificity, sensitivity, positive predictive value
(PPV), negative predictive value (NPV) and accuracy of Ranson and acute
physiology and chronic health evaluation – II (APACHE II) at 48 hours of
admission with acute pancreatitis does not correlate in determining the severity
of acute pancreatitis.