Objective: To study the relationship between CT imaging classification criteria and the prognosis of severe acute pancreatitis (SAP).
Methods: From January 2000 to December 2009, 62 cases with SAP were analyzed, retrospectively. They were all executed CT examination in 72 h after admission, and their CT imaging were classified as grade C (n = 13), grade D (n = 26), and grade E (n = 23) according to the Balthazar classification criteria and also classified as grade I (n = 11), grade II (n = 39), grade III (n = 12) according to the Balthazar CT severity index (CTSI) criteria, respectively. The values of these two different classification criteria in assessing the prognosis of SAP were studied, such as length of hospital stay, fever days, fasting days, white blood cell recovery days, serum amylase recovery days, pancreatic pseudocyst, organ failure, need for transit operations, and death. By studying the receiver operating characteristic (ROC) curves, which were drawn by the area under cures, the values of the two different classification criteria were compared in assessing the prognosis of SAP.
Results: The Balthazar classification criteria was valuable in assessing white blood cell recovery days (F = 4.035, P = 0.023) and pseudocyst (χ(2) = 8.066, P = 0.018). No statistical differences were found, however, between other clinicopathological parameters and the prognosis of SAP, according to the Balthazar classification criteria. The patients with low-grade of CTSI classification criteria enjoyed better prognosis, and patients in grade I or II got lower incidence of organ failure, need for transit operations and pseudocyst than that in grade III. The results above suggested that CTSI classification criteria, comparing with Balthazar CT classification criteria, was more valuable in predicting the incidence of organ failure, pseudocyst, need for transit operation, and mortality in SAP (P < 0.01).
Conclusion: The CTSI classification criteria has a great value in assessing the prognosis of SAP.