Computed tomographic prognostic factors for predicting local complications in patients with pancreatic necrosis.
This prospective study aimed at evaluating dynamic computed tomography (CT) as a prognostic indicator of local complications in patients with pancreatic necrosis.


METHODS
We analyze the relationship between the anatomic pattern of pancreatic necrosis at dynamic CT (pancreatic necrosis, peripancreatic necrosis, and transparenchymal necrosis) and the development of local complications (infected pancreatic necrosis and pseudocyst).


RESULTS
One hundred thirty-eight patients were included in the study. Nine patients were excluded, and 86 required surgery. Average time from the onset of symptoms to dynamic CT was 8.3 days. Multivariate analysis identified the following prognostic factors for local complications: (1) extent of pancreatic necrosis (odds ratio [OR], 7.32; 95% confidence interval [CI], 1.32-23.76; P = 0.015) and presence of peripancreatic necrosis (OR, 37.32; 95% CI, 3.77-369.38; P = 0.002) were useful to predict the development of infected pancreatic necrosis; and (2) transparenchymal necrosis with upstream viable (enhancing) pancreas (OR, 36.22; 95% CI, 3.18-412.36; P = 0.004) and no peripancreatic necrosis (OR, 0.016; 95% CI, 0.004-0.62; P < 0.001) were associated with pseudocyst development.


CONCLUSIONS
Dynamic CT prognostic factors useful to predict local complications in patients with pancreatic necrosis were the extent of pancreatic necrosis, presence of peripancreatic necrosis, and the finding of transparenchymal necrosis with upstream viable (enhancing) pancreas.
Ocampo
Carlos
C
Departments of Surgery, Cosme Argerich Hospital, Buenos Aires, Argentina. ocampoc@yahoo.com
Zandalazini
Hugo
H
Kohan
Gustavo
G
Silva
Walter
W
Szelagowsky
Carlos
C
Oría
Alejandro
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010192:Pancreatic Pseudocyst / Q000209:etiology; D010195:Pancreatitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*