title: Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis.
abstract: BACKGROUND
  The value of lung ultrasonography in the diagnosis of respiratory dysfunction and severity stratification in patients with acute pancreatitis (AP) was investigated.
  
  
  METHODS
  Over a 3-month period, 41 patients (median age: 59.1 years; 21 males) presenting with a diagnosis of potential AP were prospectively recruited. Each participant underwent lung ultrasonography, and the number of comet tails present on scans was linked with contemporaneous clinical data. Group comparisons, areas under the curve (AUC) and respective measures of diagnostic accuracy were investigated.
  
  
  RESULTS
  A greater number of comet tails were evident in patients with respiratory dysfunction (P = 0.013), those with severe disease (P = 0.001) and when contemporaneous and maximum in-patient C-reactive protein (CRP) exceeded 150 mg/l (P = 0.018 and P = 0.049, respectively). Receiver-operator characteristic plot area under the curve (AUC) was greater when examining upper lung quadrants, using respiratory dysfunction and AP severity as variables of interest (AUC = 0.803, 95% CI: 0.583-1.000, and AUC = 0.996, 95% CI: 0.983-1.000, respectively). Examining all lung quadrants resulted in greater AUCs for contemporaneous and maximum CRP (AUC = 0.764, 95% CI: 0.555-0.972, and AUC = 0.704, 95% CI: 0.510-0.898).
  
  
  CONCLUSIONS
  Ultrasonography of non-dependent lung parenchyma can reliably detect evolving respiratory dysfunction in AP. This simple bedside technique shows promise as an adjunct to severity stratification.
authors.affiliation: Clinical Surgery, The University of Edinburgh, Edinburgh, UK.
authors.forename: Christos
authors.identifier: http://orcid.org/0000-0002-0568-8321
authors.initials: C
authors.lastname: Skouras
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Zoe A
authors.initials: ZA
authors.lastname: Davis
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Sharkey
authors.affiliation: Clinical Surgery, The University of Edinburgh, Edinburgh, UK.
authors.forename: Rowan W
authors.initials: RW
authors.lastname: Parks
authors.affiliation: Clinical Surgery, The University of Edinburgh, Edinburgh, UK.
authors.forename: James O
authors.initials: JO
authors.lastname: Garden
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: John T
authors.initials: JT
authors.lastname: Murchison
authors.affiliation: Clinical Surgery, The University of Edinburgh, Edinburgh, UK.|MRC Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Mole