title: Early nonenhanced abdominal computed tomography can predict mortality in severe acute pancreatitis.
abstract: We wondered whether nonenhanced computed tomography (CT) within 48 hours of admission could identify individuals at risk for higher mortality from acute pancreatitis. Data from the international phase III study of the platelet-activating factor-inhibitor Lexipafant was used to analyze noncontrast CT versus acute pancreatitis mortality. Nonenhanced CT examinations of the abdomen from the trial were classified by disease severity (Balthazar grades A-E) and then correlated with patient survival. Among the 477 individuals who underwent CT within 48 hours of admission and 220 individuals who did so over the subsequent 6 days, higher CT grades were associated with increased mortality. Each unit increase in Balthazar grade during the initial 48 hours was associated with an estimated increase in the risk of mortality of 33%, and this trend increased to 50% if pancreatic enlargement and peripancreatic stranding (grades B and C) were combined (P<0.05). CT grade correlated minimally with Ranson, Glasgow, or APACHE II score during the initial 48 hours; however, this correlation improved over 3-8 days. Early nonenhanced abdominal CT in patients with acute pancreatitis is a valuable prognostic indicator of mortality in acute pancreatitis, even among patients without clinical features of severe acute pancreatitis.
authors.affiliation: Department of Surgery, University of California, San Francisco and East Bay 94143-0104, USA.
authors.forename: Austin L
authors.initials: AL
authors.lastname: Spitzer
authors.forename: Ruedi F
authors.initials: RF
authors.lastname: Thoeni
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Barcia
authors.forename: Michael T
authors.initials: MT
authors.lastname: Schell
authors.forename: Hobart W
authors.initials: HW
authors.lastname: Harris
mesh_terms: D018806:APACHE; D000208:Acute Disease; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D005544:Forecasting; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007930:Leucine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000145:classification / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010919:Placebos; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007093:Imidazoles; D010919:Placebos; D010972:Platelet Activating Factor; D007930:Leucine; C103289:lexipafant