Study Of The Correlation Between The Severity, Prognosis Of AP And The CT Changes Of The Tissue Adjacent To Pancreas Involved With AP

Objective:To investigate the correlation between the severity,prognosis of AP and the CT changes of the tissue adjacent to Pancreas involved with Acute pancreatitis, for determining the CT signs which can identify SAP early and predict the prognosis of AP.Method:The clinical data and CT images of 100 patients with AP, treated in Second Hospital of Hebei Medical University hospital with CT examination and review in our department were collected and analyzed retrospectively. The CT changes of the tissue which can be observed in routine epigastric CT examination and adjacent to pancreas involved with AP were observed,such as pleural cavity, abdominal cavity, liver, duodenum, colon, renal fascia, perirenal space and posterior pararenal space. To investigate the dependablity between the CT changes and severity,prognosis of AP. According to the severity of AP,patients were divided into two groups of SAP and MAP. Prognostic indicators include hospital days, intensive care days, fasting days, fever days, pseudocyst formation and multiple organ dysfunction syndrome (MODS), surgery and mortality.Result:Pleural effusion, ascites, hepatic lesion, edema and thickening of the duodenum and the Ascending and / or descending colon, thickening of renal fascia, increased density of Perirenal space and Posterior pararenal space were all significant differences between the two groups of SAP and MAP, That are associated with the severity of AP, the strongest correlation with pleural effusion.(P=0.00,C=0.62,OR=121.5).44 cases with pleural effusion, the incidence rate was 44%. SAP group 36 patients Accounting for 82%, group incidence of 95%, MAP group 8 patients 18%, group incidence of 13%; 24 male and 36% incidence in male group, 20 female and 59% incidence in female group, female are more vulnerable than male with pleural effusion in AP; Bilateral and left pleural effusion more common,26 cases with bilateral pleural effusion, accounting for 59%,left 16 cases accounted for 36% and right only 4% in 2 cases, The site of effusion and the severity, prognosis of AP had no correlation.24 cases with ascites, the incidence rate was 30%. SAP group 22 patients accounting for 73%, group incidence of 95%, MAP group 2 patients 8%, group incidence of 3%, x2 value of 38.60, P = 0.00 <0.05, the C and OR values were 0.53,41.3; 42 cases with hepatic lesion, the incidence rate was 42%. SAP group 22 patients accounting for 52%, group incidence of 58%, MAP group 20 patients 42%, group incidence of 32%, x2 value of 6.36, P = 0.012 <0.05, the C and OR values were 0.24,2.9.42 cases with Edema and thickening of duodenum, the incidence rate was 42%. SAP group 28 patients accounting for 67%, group incidence of 74%, MAP group 14 patients 33%, group incidence of 23%, x2 value of 25.26, P = 0.00 <0.05, the C and OR values were 0.45,9.6; 34 cases with edema and thickening of the ascending and / or descending colon, the incidence rate was 34%. SAP group 24 patients accounting for 71%, group incidence of 63%, MAP group 10 patients 29%, group incidence of 16%, x2 value of 23.22, P = 0.00 <0.05, the C and OR values were 0.43,8.9.Thickening of renal fascia, increased density of perirenal space and posterior pararenal space were 66 cases, 52 cases, 18 cases, incidence rates were 66%, 52% and 18%. Thickening of renal fascia of two groups of SAP, MAP were 38 cases (100%) and 28 patients (45%), increased density of perirenal space of two groups of SAP, MAP were 30cases (79%) and 22 patients (35%), increased density of posterior pararenal space of two groups of SAP, MAP were 16 cases (42%) and 2 patients (3%). x2 value were 31.57,17.83,14.27,P=0.00<0.05,C value were 0.49,0.39,0.35,and OR value were 44.9,6.8,13.1.Pleural effusion was positively correlated with the grade of CTSI score with the AP. 6 patients with pleural effusion in Class I(46 cases) accounting for 13%, 24 patients with pleural effusion in Class II(40 cases) accounting for 60%, All of Class III(14 cases) had pleural effusion accounting for 100%. CTSI grading with increased incidence of pleural effusion in a significantly higher. x2 value of 39.87, C=0.53,P=0.00<0.05.Pleural effusion had high predictive value for SAP, sensitivity of 95%,specificity of 87%, positive predictive value of 82%, and negative predictive value of 95%.The prognosis of patients with pleural effusion were worse than without pleural effusion. The duration of hospitalization were 18.7±7.1 days and 10.7±3.8 days in patients with Pleural effusion and without, duration of fasting were 9.8±5.1 and 4.8±2.6 days, duration of intensive care were 3.2±3.3 and 0.57±1.4 days, duration of fever were 3.2±3.0 and 0.86±1.4 days, P=0.00<0.05, the duration of hospitalization , fasting, intensive care and fever of patients with pleural effusion were longger than without pleural effusion. In the pleural effusion group, 18 cases had pseudocyst accounting for 41%,surgery in 6 case 14%,10 cases with MODS 23%, and 2 cases died with death rate of 4%,while without pleural effusion group 6 cases had Pseudocyst accounting for 11%, surgery in 2 case 4%, no MODS and death. All P <0.05.Conclusion:1 Pleural effusion, ascites, hepatic lesion, edema and thickening of the duodenum and the ascending and / or descending colon, thickening of renal fascia, increased density of perirenal space and posterior pararenal space all were associated with the severity of AP.2 Pleural effusion is a independence of prognosis indicators of the severity of AP.3 The site and fluid volume of pleural effusion has no correlation with the condition.4 Pleural effusion associated with pseudocyst.5 Propose add the pleural effusion into the CTSI scoring system, for it can determine the condition and prognosis of AP more fully and accurately.