IS TOMOGRAPHY SEVERİTY INDEX A PREDİCTOR OF PROGNOSİS AND COMPLICATIONS FOR ACUTE PANCREATİTİS?

Abstract

The mainstay of the treatment in acute pancreatitis is the evaluation of severity of the disease. Various methods of clinical, radiological and biochemical as Ranson criteria, Glasgow scale, APACHE II scorring, peritoneal lavage, abdominal computerized tomography etc. have been used to determine the severity score of the disease. However nobody is still in agreement on a common diagnostic tool in acute pancreatitis. In fact,tomography severity index (TSI) is considered to be superior to the others.

In this study, tomography severity index, Ranson criteria and Glasgow scale were compared in terms of the efficacy in determining further complications and also the prognosis of ninety patients with acute pancreatitis. While Ranson criteria and Glasgow scale were used in first 48 hours, tomography severity index was used in the first five days of admission. The patients with 3 ≥ scores for Ranson criteria and Glasgow scale and the ones with 6> scores for TSI were accepted as severe pancreatitis.

In this study, the sensitivity and specificity of TSI were better than Ranson criteria and Glasgow scale but no differences were found for sensitivity among these three parameters. The specificity of TSI was better than Glasgow scale with statistically significance (p<0.05). However, no statistically difference was found between the specificity of Ranson criteria and TSI. On the other hand, TSI was superior to Ranson criteria and also Glasgow scale in terms of positive predictive value (p<0.05).

TSI was also showed better results with statistically significance for demonstration of pancreatic necrosis, indication of necrosectomy and visualization of peripancreatic fluid collection when compared to Ranson criteria and Glasgow scale (p<0.05). Mortality did not seem to be affected statistically by the three parameters (p>0.05). In conclusion, TSI are better than Ranson and Glasgow scoring systems for prediction of the severity of the disease and local pancreatic complications.