Clinical application value of Balthazar CT classification and EPIC score in acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANG Xin , XIA Zhiying , YANG Guoyun

Department of Radiology, Hainan Academy of Traditional Chinese Medicine, Haikou 570102, P. R. China;

Corresponding?author：

WANG Xin, Email: byww189@163.com

Keywords：

acute pancreatitis; CT scanning; severity; diagnosis

DOI：

10.7507/1007-9424.202109076

Video：

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Objective To explore the consistency and clinical application value of Balthazar CT classification and extra-pancreatic inflammation on computed tomography (EPIC) score in the diagnosis of acute pancreatitis (AP). Methods A total of 100 continuous patients with AP were included in the Hainan Academy of Traditional Chinese Medicine from April 2019 to April 2021, who were divided into mild (n=41), moderate (n=37), and severe (n=22) AP, and all of them underwent the abdominal CT examination. The Balthazar CT classification score, EPIC score, and acute physiology and chronic health evaluation Ⅱ (APACHE-Ⅱ) score were compared and the correlations were analyzed among 3 groups. The consistency of Balthazar CT classification score or EPIC score and clinical classification was analyzed. Results There were statistical differences in the Balthazar CT classification score [(1.58±0.29) points vs. (2.43±0.36) points vs. (3.20±0.51) points, F=13.261, P<0.001], EPIC score [(2.56±0.30) points vs. (4.29±0.77) points vs. (5.68±0.82) points, F=14.672, P<0.001], and APACHE-Ⅱ score [(21.40±6.22) points vs. (29.13±7.31) points vs. (39.37±8.18) points, F=13.906, P<0.001] among mild, moderate, and severe 3 groups. The points of the three indexes increased statistically with the severity of AP (P<0.05). The Balthazar CT classification score was positively correlated with APACHE-Ⅱ score and EPIC score (r=0.537, P<0.001; r=0.609, P<0.001), and EPIC score was positively correlated with APACHE-Ⅱ score (r=0.582, P<0.001). The Kappa values of Balthazar CT classification score or EPIC score and clinical classification for assessing the severity of AP were 0.731 and 0.704, respectively. Conclusions From the preliminary results of this study, Balthazar CT classification score and EPIC score increase obviously with the aggravation of AP and which has a higher consistency, and are positively correlated with APACHE-Ⅱ score. It is suggested that abdominal CT has a good clinical application value in the assessment of severity of AP.

Citation： WANG Xin, XIA Zhiying, YANG Guoyun. Clinical application value of Balthazar CT classification and EPIC score in acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 939-942. doi: 10.7507/1007-9424.202109076 Copy

1.	吳長安, 周保東, 孫建. 重癥胰腺炎治療新進展. 臨床心身疾病雜志, 2020, 26(5): 122-124.
2.	馬進坡, 徐德全, 趙加斌, 等. 降鈣素原在急性胰腺炎及胰腺感染中的價值. 中國普外基礎與臨床雜志, 2021, 28(1): 130-134.
3.	Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology, 2019, 156(7): 2008-2023.
4.	Leung VJ, Godfrey EM, Biddle DJ, et al. Split-bolus single-pass CT for vascular complications in acute pancreatitis: assessment of radiation dose and multi-phasic contrast enhancement compared to single-bolus multi-pass CT. Clin Radiol, 2020, 75(8): 644. e1-644. e6. doi: 10.1016/j.crad.2020.05.002.
5.	汪翊, 冷琦, 黃子星, 等. 三種CT評分與急性胰腺炎嚴重程度床邊指數評分評估重癥急性胰腺炎的相關性研究. 中國普外基礎與臨床雜志, 2015, 22(12): 1520-1524.
6.	雷靜. 急性胰腺炎及其并發癥內鏡治療的進展. 檢驗醫學與臨床, 2020, 17(20): 3046-3050.
7.	盧磊, 周舒, 陳劉成. 比較磁共振成像與CT對急性胰腺炎診斷價值的薈萃分析. 實用放射學雜志, 2020, 36(5): 759-763, 787.
8.	中華醫學會消化病學分會胰腺疾病學組, 《中華胰腺病雜志》編委會, 《中華消化雜志》編委會. 中國急性胰腺炎診治指南(2019年, 沈陽). 臨床肝膽病雜志, 2019, 35(12): 2706-2711.
9.	張怡, 譚輝, 劉寧, 等. 血清sPD-L1聯合Balthazar CT分級對急性胰腺炎患者后期胰周壞死感染的預測能效. 河北醫學, 2021, 27(8): 1325-1329.
10.	朱代華, 張興明, 李鉞, 等. APACHE-Ⅱ評分對重癥急性胰腺炎的臨床意義. 第三軍醫大學學報, 2001, 23(8): 986-987.
11.	郭曉鐘. 急性胰腺炎營養支持治療的研究進展. 中華消化雜志, 2020, 40(7): 437-440.
12.	王春友. 急性壞死性胰腺炎治療的歷史與現狀: 百年探索二十年突破. 中華外科雜志, 2020, 58(1): 9-12.
13.	李莉, 寧華英, 劉暉, 等. 重癥急性胰腺炎患者營養風險篩查與臨床結局的相關性及價值探討. 重慶醫學, 2020, 49(9): 1413-1416.
14.	呂農華, 何文華. 重癥急性胰腺炎的診治難點與對策. 中華消化雜志, 2020, 40(7): 433-436.
15.	鄒萍, 管英, 李繼兵. 多層螺旋CT三期增強掃描對急性胰腺炎的診斷價值探討. 中國CT和MRI雜志, 2020, 18(12): 84-86.
16.	Boumezrag M, Harounzadeh S, Ijaz H, et al. Assessing the CT findings and clinical course of ED patients with first-time versus recurrent acute pancreatitis. Am J Emerg Med, 2019, 37(2): 304-307.
17.	Hérin E, Sauvanet A, Cros J, et al. Recurrent acute pancreatitis caused by combined gastric and pancreatic duplications: value of preoperative CT and MRCP and conservative surgery. J Surg Case Rep, 2020, 2020(8): rjaa175. doi: 10.1093/jscr/rjaa175.
18.	蘇凱燕, 劉增韜. CT影像診斷對急性胰腺炎的診斷研究. 現代醫用影像學, 2021, 30(1): 117-119.
19.	魯開文, 亓小虎, 冉國民. 腹部CT用于診斷胰腺炎患者病情嚴重程度的價值. 武漢大學學報(醫學版), 2021, 42(3): 494-497.
20.	Badat N, Millet I, Corno L, et al. Revised Atlanta classification for CT pancreatic and peripancreatic collections in the first month of acute pancreatitis: interobserver agreement. Eur Radiol, 2019, 29(5): 2302-2310.
21.	Zver T, Calame P, Koch S, et al. Early prediction of acute biliary pancreatitis using clinical and abdominal CT features. Radiology, 2022, 302(1): 118-126.
22.	Evrimler ?, ?akmak?? M, Karaibrahimo?lu A, et al. The prognostic value of fat necrosis deposits on CT imaging in acute pancreatitis. Turk J Med Sci, 2021, 51(2): 749-756.
23.	徐美愛, 胡曉有, 董伶俐. 改良CT嚴重指數在急性胰腺炎患者病情評估中的應用價值. 現代實用醫學, 2019, 31(5): 691-692.
24.	李成, 王麗, 李建紅, 等. 血清甘油三酯與IL-6及APACHEⅡ評分對重癥急性胰腺炎患者感染及預后的預測價值. 中華醫院感染學雜志, 2020, 30(20): 3125-3129.
25.	潘鑫鑫, 任小丹, 何元群, 等. 血鈣聯合APACHEⅡ評分對急性胰腺炎重癥傾向的預測研究. 重慶醫學, 2020, 49(10): 1648-1652.

1. 吳長安, 周保東, 孫建. 重癥胰腺炎治療新進展. 臨床心身疾病雜志, 2020, 26(5): 122-124.
2. 馬進坡, 徐德全, 趙加斌, 等. 降鈣素原在急性胰腺炎及胰腺感染中的價值. 中國普外基礎與臨床雜志, 2021, 28(1): 130-134.
3. Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology, 2019, 156(7): 2008-2023.
4. Leung VJ, Godfrey EM, Biddle DJ, et al. Split-bolus single-pass CT for vascular complications in acute pancreatitis: assessment of radiation dose and multi-phasic contrast enhancement compared to single-bolus multi-pass CT. Clin Radiol, 2020, 75(8): 644. e1-644. e6. doi: 10.1016/j.crad.2020.05.002.
5. 汪翊, 冷琦, 黃子星, 等. 三種CT評分與急性胰腺炎嚴重程度床邊指數評分評估重癥急性胰腺炎的相關性研究. 中國普外基礎與臨床雜志, 2015, 22(12): 1520-1524.
6. 雷靜. 急性胰腺炎及其并發癥內鏡治療的進展. 檢驗醫學與臨床, 2020, 17(20): 3046-3050.
7. 盧磊, 周舒, 陳劉成. 比較磁共振成像與CT對急性胰腺炎診斷價值的薈萃分析. 實用放射學雜志, 2020, 36(5): 759-763, 787.
8. 中華醫學會消化病學分會胰腺疾病學組, 《中華胰腺病雜志》編委會, 《中華消化雜志》編委會. 中國急性胰腺炎診治指南(2019年, 沈陽). 臨床肝膽病雜志, 2019, 35(12): 2706-2711.
9. 張怡, 譚輝, 劉寧, 等. 血清sPD-L1聯合Balthazar CT分級對急性胰腺炎患者后期胰周壞死感染的預測能效. 河北醫學, 2021, 27(8): 1325-1329.
10. 朱代華, 張興明, 李鉞, 等. APACHE-Ⅱ評分對重癥急性胰腺炎的臨床意義. 第三軍醫大學學報, 2001, 23(8): 986-987.
11. 郭曉鐘. 急性胰腺炎營養支持治療的研究進展. 中華消化雜志, 2020, 40(7): 437-440.
12. 王春友. 急性壞死性胰腺炎治療的歷史與現狀: 百年探索二十年突破. 中華外科雜志, 2020, 58(1): 9-12.
13. 李莉, 寧華英, 劉暉, 等. 重癥急性胰腺炎患者營養風險篩查與臨床結局的相關性及價值探討. 重慶醫學, 2020, 49(9): 1413-1416.
14. 呂農華, 何文華. 重癥急性胰腺炎的診治難點與對策. 中華消化雜志, 2020, 40(7): 433-436.
15. 鄒萍, 管英, 李繼兵. 多層螺旋CT三期增強掃描對急性胰腺炎的診斷價值探討. 中國CT和MRI雜志, 2020, 18(12): 84-86.
16. Boumezrag M, Harounzadeh S, Ijaz H, et al. Assessing the CT findings and clinical course of ED patients with first-time versus recurrent acute pancreatitis. Am J Emerg Med, 2019, 37(2): 304-307.
17. Hérin E, Sauvanet A, Cros J, et al. Recurrent acute pancreatitis caused by combined gastric and pancreatic duplications: value of preoperative CT and MRCP and conservative surgery. J Surg Case Rep, 2020, 2020(8): rjaa175. doi: 10.1093/jscr/rjaa175.
18. 蘇凱燕, 劉增韜. CT影像診斷對急性胰腺炎的診斷研究. 現代醫用影像學, 2021, 30(1): 117-119.
19. 魯開文, 亓小虎, 冉國民. 腹部CT用于診斷胰腺炎患者病情嚴重程度的價值. 武漢大學學報(醫學版), 2021, 42(3): 494-497.
20. Badat N, Millet I, Corno L, et al. Revised Atlanta classification for CT pancreatic and peripancreatic collections in the first month of acute pancreatitis: interobserver agreement. Eur Radiol, 2019, 29(5): 2302-2310.
21. Zver T, Calame P, Koch S, et al. Early prediction of acute biliary pancreatitis using clinical and abdominal CT features. Radiology, 2022, 302(1): 118-126.
22. Evrimler ?, ?akmak?? M, Karaibrahimo?lu A, et al. The prognostic value of fat necrosis deposits on CT imaging in acute pancreatitis. Turk J Med Sci, 2021, 51(2): 749-756.
23. 徐美愛, 胡曉有, 董伶俐. 改良CT嚴重指數在急性胰腺炎患者病情評估中的應用價值. 現代實用醫學, 2019, 31(5): 691-692.
24. 李成, 王麗, 李建紅, 等. 血清甘油三酯與IL-6及APACHEⅡ評分對重癥急性胰腺炎患者感染及預后的預測價值. 中華醫院感染學雜志, 2020, 30(20): 3125-3129.
25. 潘鑫鑫, 任小丹, 何元群, 等. 血鈣聯合APACHEⅡ評分對急性胰腺炎重癥傾向的預測研究. 重慶醫學, 2020, 49(10): 1648-1652.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application value of Balthazar CT classification and EPIC score in acute pancreatitis

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