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 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 = 0.021), those with severe disease (P < 0.001) and when contemporaneous and maximum CRP exceeded 100 mg/L (P = 0.048 and P = 0.003 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 = 0.783, 95% C.I.: 0.544-0.962, and AUC = 0.996, 95% C.I.: 0.982-1.000, respectively). Examining all lung quadrants except for the lower lateral resulted in greater AUCs for contemporaneous and maximum CRP (AUC = 0.708, 95% C.I.: 0.510-0.883, and AUC = 0.800, 95% C.I.: 0.640-0.929).
  
  
  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, School of Clinical Sciences, The University of Edinburgh, United Kingdom. Electronic address: christos.skouras@ed.ac.uk.
authors.forename: Christos
authors.initials: C
authors.lastname: Skouras
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, United Kingdom.
authors.forename: Zoe A
authors.initials: ZA
authors.lastname: Davis
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Sharkey
authors.affiliation: Clinical Surgery, School of Clinical Sciences, The University of Edinburgh, United Kingdom.
authors.forename: Rowan W
authors.initials: RW
authors.lastname: Parks
authors.affiliation: Clinical Surgery, School of Clinical Sciences, The University of Edinburgh, United Kingdom.
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, United Kingdom.
authors.forename: John T
authors.initials: JT
authors.lastname: Murchison
authors.affiliation: Clinical Surgery, School of Clinical Sciences, The University of Edinburgh, United Kingdom; MRC Centre for Inflammation Research, The University of Edinburgh, United Kingdom.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Mole
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis; D010865:Pilot Projects; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012120:Respiration Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D012129:Respiratory Function Tests / Q000379:methods*; D012720:Severity of Illness Index; D014463:Ultrasonography