Early Application Of CT Evaluation System Combined With D-dimer To Assess The Prognosis Of Severe Acute Pancreatitis

Objective: In the present study,we observed the Balthazar CT grading,the modified CT severity index(MCTSI)and the plasma concentration of D-dimer in patients with SAP,explore the relationship respectively between them andtheprognosis of patients,and further explore therelationship between CT evaluation system and D-dimer and the combination of the two on the prognosis of SAP patients.Methods: The general data of 73 patients with SAP from Jan.2014 to Dec.2016 in the Second Affiliated Hospital of Dalian Medical Universitywere analyzed retrospectively.The age distribution of the patients was 19 to 89 years old.All patients were completed within 24 hours of serum D-dimer examination,within 48 hours of the abdominal CT examination(including plain CT and contrast-enhanced CT).Took conservative treatment to the selected patients in the early time.According to Balthazar CT grading criteria,allpatients were classified as low grade and high grade.According to the MCTSI scoring criteria,patientsweredivided into low and high groups in all cases.Make D-dimer is 2μg / ml as the boundary,allpatientsweredivided into low-level group and high-level group.The correlations of Balthazar CT grade,MCTSI score and D-dimer level with clinical parameters such as hospitalization days and mortalitywere analyzed.The receiver operating characteristic curve(ROC)was plotted on the Balthazar CT grade,MCTSI score and D-dimer level of all patients.The area under the curve(AUC)was calculated to compare the value of the three criteria for SAP prognosis.The relationship between CT evaluation system and D-dimer level was analyzed and the effect of the two groups on the prognosis of SAP patients was analyzed.Statistical data were expressed as mean(±)standard deviation,compared between groups using t test or analysis of variance;classification of statistical analysis using chi-square test.The difference was statistically significant at P <0.05.Results: The time of hospitalization,the ICU admission rate,the operation rate and mortality were lower in the junior group than those in the senior group for the Balthazar CT grade and MCTSI score.For the Balthazar CT grade,the time of hospitalization(P =0.000)and mortality(P = 0.029)in the two groups were statistically significant.For the MCTSI score,the time of hospitalization(P = 0.000)and mortality(P = 0.039)were statistically significant.The mortality rate was significantly higher in the high-D group than in the low-level group(P = 0.044).ROC curve analysis showed that the AUC value of the Balthazar CT grade was 0.722(95% CI: 0.560 to 0.884),the AUC value of the modified CT severity index was 0.694(95% CI: 0.515 to 0.872),the AUC value of the D-dimer is 0.760(95% CI: 0.616 to 0.905).All three can predict the occurrence of SAP death,the area under the curve comparison: D-dimer>Balthazar CT classification>modified CT severity index score.The relationship between D-dimer and CT evaluation system was further studied.The plasma D-dimer level in patients with high CT grade was significantly higher than that in patients with low CT grade,the difference was statistically significant(P <0.05).Similarly,plasma D-dimer levels were significantly higher in patients with high MCTSI scores than those with low MCTSI scores(P <0.05).Early CT grade and D-dimer levels were higher,the patient’s prognosis was poor.Similarly,early MCTSI scores and D-dimer levels were higher,the prognosis was poor.Conclusion: 1.Early CT evaluation system and D-dimer levels can assess the prognosis of patients with severe acute pancreatitis,early D-dimer CT evaluation system can more accurately predict the occurrence of death on SAP patients;2.CT evaluation system and D-dimer level,the early combination of the two may improve the prognosis of severe acute pancreatitis assessment,then to guide clinical treatment and reduce mortality.