To determine the relationship between acute fluid collections (AFCs) detected by ultrasound imaging (US) and the severity of acute pancreatitis (AP).
METHOD AND MATERIALS
Retrospective analysis of US scans performed on 627 patients with AP diagnosed between 01/96 and 12/98. The initial US scans were obtained on day 1 or 2 of the patients’ hospital admission. Follow-up US scans were performed between day 3 and 7 after the initial scans. The pancreas and potential spaces (i.e., lesser sac, pararenal spaces, peritoneal cavity, and thoracic cavity) were evaluated sonographically and patients were divided into 4 groups according to the number of spaces (0, 1, 2, >2) that contained fluid. Clinical treatment and final outcome results were analyzed and compared to the US findings. Continuous variables were analyzed by t-test. Discrete variables were analyzed by the Χ² test and rank sum test using SPSS.
There were 266 patients in the 0 AFC group; 256 had mild AP and 10 had severe AP. Of the 104 patients in the 1 AFC group 91had mild AP and 13 had severe AP. There were 93 patients in the 2 AFC group; 75 had mild AP and 18 had severe AP. Of the 164 patients in the >2 AFC group 80 had mild AP and 84 had severe AP. Of the 502 patients with mild AP, 51% were in the 0 AFC group, 18.1% were in the 1 AFC group, 15% were in the 2 AFC group and 15.9% were in the >2 AFC group. Of the 125 patients with severe AP, 8% were in the 0 AFC group, 10.4% were in the 1 AFC group, 14.4% were in the 2 AFC group and 67.2% were in the >2 AFC group. The number of sites of AFC were related to the severity of AP and to the hospital stay of patients (P<0.00001, Χ²=161.47, DF=3), to the prevalence of local complications, to the need for surgery and patient mortality. The sensitivity, specificity and accuracy were 67.2%, 84.2% and 80.1% respectively if using >2 AFC sites to distinguish mild AP from severe AP.
These results suggest that US findings can be used as an early prognostic indicator for the severity of AP by detecting the number of spaces that contain AFCs.
Y.L.,C.Y.,J.J.,P.W.,Y.P.,Z.Z.: This study was supported by Clinical Key Subject Fund of Ministry of Public Health of China (No. 97050234)