Value of clinical criteria to indicate a CT-FNA in the diagnosis of infected acute pancreatitis.
OBJECTIVE
To assess the value of clinical criteria in detecting pancreatic infection (PI) on or after the seventh day of acute pancreatitis attack (AP).


METHODS
We determined as clinical criteria of suspicion of PI (SPI): the presence, persistence or recurrence of fever > or = 38 degrees C, leukocytosis > or = 12,000/mm3 and organ failure (OF) in the absence of extrapancreatic infection. Patients with SPI criteria underwent computed tomography - fine needle aspiration (CT-FNA), if CT-FNA was negative and SPI criteria for 72 hours CT-FNA was repeated.


RESULTS
We prospectively studied 369 patients with AP and found 48 patients who met SPI criteria (mean age 37 yr, 17-70 yr), 30 male and 18 female. Etiology was biliary (56.2%), alcohol (35.4%) and others (8.4%). We performed 53 CT-FNA in 48 patients and 28 were diagnosed with PI. At the time of CT-FNA 50% of patients had OF. Mean time for CT-FNA in patients with PI was 12.5 +/- 7 days. Mean clinical followup after hospital discharge was one month. No patients with SPI criteria and negative CT-FNA or patients without SPI criteria developed clinical signs of PI. The SPI criteria had a sensitivity of 100%, specificity of 94% (CI 95% 92-97), PPV of 58% (IC 95% 44-72) and NPV of 100%.


CONCLUSIONS
The application of SPI criteria on or after the seventh day of onset of AP can be a useful tool in making the decision and defining the time to perform a CT-FNA in order to clarify the clinical scenario between SIRS and sepsis related PI. Our approach can lead to better strategic treatments in the management of these difficult cases.
González-González
José A
JA
Facultad de Medicina y Centro Regional para el Estudio de Enfermedades Digestivas (CREED), Hospital Universitario Dr José Eleuterio González, UANL Monterrey, NL México. joseagonz@yahoo.com
Calderón-Lozano
Irma E
IE
Maldonado-Garza
Héctor
H
Mendoza-Fuerte
Eduardo
E
Garza-Galindo
Aldo A
AA
García-Cantú
Dora A
DA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis*; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000382:microbiology / Q000473:pathology; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis; D014057:Tomography, X-Ray Computed