[Predictive evaluation of acute necrotizing pancreatitis: results of a prospective study]. / Evaluation prédictive de la pancréatite aiguë nécrosante: résultats d'une étude prospective.

ABSTRACT

OBJECTIVES: The aim of this study has been to evaluate the prognostic efficiency of some indexes based on biochemical and clinical criteria and computed tomography (CT) findings in the early phase of necrotizing acute pancreatitis. METHODS: Prospective evaluation of 53 patients selected in two groups a) 21 cases with severe prognosis (11 deaths and 10 patients with a complicated clinical outcome of more than 3 months) and b) 32 cases with lighter prognosis (clinical recovery within 3 months and no deaths). The prognostic indexes we considered were CT-scan score, simplified prognostic criteria, modified Glasgow criteria, Hong-Kong criteria and C-reactive Protein serum value. RESULTS: The best values of sensitivity were obtained by C-reactive protein (100%) and CT findings (90.4%), the best values of specificity by Hong-Kong criteria (87.5%) and of efficiency by CT (85.1%). As concerns sensitivity, the statistical comparison (McNemar test) showed a significantly lower Hong-Kong level versus all the other indexes and a significantly greater level C-reactive protein versus simplified prognostic criteria and modified Glasgow score. The comparison of the specificity results showed a significantly greater level of CT, Hong-Kong and simplified prognostic criteria versus C-reactive protein and versus modified Glasgow score. Associating CT-score with Hong-Kong improved the value of specificity (90.3%) and efficiency (90.3%). CONCLUSIONS: Contrast enhancement CT-scan score showed the most valuable prognostic efficiency early during a severe form of necrotizing acute pancreatitis the association with a simple biochemical index like Hong-Kong criteria (based on blood urea and glucose) yields an even greater accuracy in prognostic evaluation.