Moderately Severe Acute Pancreatitis: Correlations Between Modified CT Severity Index And Clinical Condition

Objective：Confirm of the diagnostic value of CT inMSAP(moderately severe acute pancreatitis) and the correlation ofMCTSI(modified CT severity index) and clinical condition in MSAP.Typing and judging the extent of the disease and clinical relevanceaccording to the CT signs.it plays a part in enacting reasonableTreatment Protocols and judging prognosis. To prevent complication anddepress fatality rate.Methods: Collected198patients diagnosis of MSAPrandomly from January2011to December2014in the digestive systemdepartment of Sichuan Academy of Medical Sciences&SichuanProvincial People’s Hospital.(146males and52females with averageage of49±13years), The CT scan data were compared with clinical dataafter the pancreas enhanced CT examination， Local or systemiccomplications including [acute peripancreatic fluid Collection(APFC)、acute necrotic collection(ANC)、 Pancreatic pseudocyst、 walled-offnecrosis（WON）、Pancreatic cysts、Pleural effusion, gastric outflowobstruction, gastrointestinal fistula, abdominal bleeding, bleedingpseudocyst, splenic vein or portal vein thrombosis, necrotizingenterocolitis, systemic inflammatory response syndrome (SIRS), systemicinfections, intra-abdominal hypertension (IAH) or abdominalcompartment syndrome (ACS), pancreatic encephalopathy (PE) and asexual organ failure (respiratory, circulatory, kidney)].Observation ofMCTSI and complication, the result of biochemical index. thecorrelation between MCTSI score and clinical grading. Results:(1)Incases associated with single or multiple complications in MCTSI concentrated in4,6,8,10score segment, constituent ratio was35.6%;42%;18.7%;3.7%. MCTSI moderate acute pancreatitis, the higher the score,the more severe clinical disease.(2)In scores of cases8,10MCTSI group,serum amylase and urine amylase decreased significantly, and10cases ofdecreased more significantly (P <0.05); while CRP values weresignificantly higher, and10group increased more significantly (P <0.05);calcium values decreased significantly, and10more groups decreasedsignificantly (P <0.05); differences were statistically significant. Higherscores indicate MCTSI, changes in biochemical markers of moderateacute inflammatory reaction of the more significant degree, the moresevere the disease.(3)ACHE Ⅱ score greater than or equal to8points inthe case group, MCTSI concentrated in groups of4to10score.Thehigher of the MCTSI score, The higher of the APACHE Ⅱscore, themore serious of the pathogenetic condition, both of them are positivecorrelation(χ2=11.9572;P=0.0177; coefficient=0.1549).(4)Rason scoregreater than or equal to3points in the case group, MCTSI concentratedin groups of4to10score.The higher of the MCTSI score, The higher ofthe Rason score, the more serious of the pathogenetic condition, both ofthem are positive correlation(χ2=9.7670;P=0.0445; coefficient=0.1266).(5)BISAP score greater than or equal to3points in the casegroup, MCTSI concentrated in groups of4to10score.The higher of theMCTSI score, The higher of the BISAP score, the more serious of thepathogenetic condition, both of them are positivecorrelation(χ2=10.6566;P值=0.0307; coefficient=0.1461).Conclusions:Application pancreas enhanced CT examination MCTSI evaluationsystem is to diagnose moderate acute pancreatitis most simple andaccurate method. The CT-inflammatory and necrotic grading, MCTSI,combining clinical score can confirm the diagnosis, assessment of disease, clinical classification, prognosis and guiding treatment has importantclinical value.