COMPARITIVE ANALYSIS OF CT SEVERITY INDICES IN PREDICTING THE SEVERITY & CLINICAL OUTCOME IN PATIENTS WITH ACUTE PANCREATITIS
Description
Acute pancreatitis is a disease of unpredictable severity & it’s management is based on the initial assessment of the disease severity. Acute Pancreatitis ranges from mild interstitial form to severe necrotic form. Evidence suggests that severe necrotic form is associated with poor prognosis. It’s a well known fact that Contrast enhanced Computed Tomography (CT) Abdomen is gold standard in early detection of pancreatic necrosis and in assessing the severity of acute pancreatitis. There are two CT severity grading systems to assess the severity of acute pancreatitis namely the CT severity Index (CSI) & Modified CT severity Index (MCSI). This study aims to compare the usefulness of these two CT severity grading systems in predicting severity & clinical outcome in acute pancreatitis patients in comparison with the clinical outcome parameters & Ranson’s criteria wherever possible. This is a hospital-based prospective screening test study conducted on 80 patients (23% Females (n=18) & 78% males (n=62)) above the age of 12 years with the clinical diagnosis of acute pancreatitis who underwent CECT study of the abdomen. The comparative analysis between CSI & MCSI with Ranson’s criteria was assessed by Chi-Square test with p-value of less than 0.05 as level of significance & Pearson correlation with r-value of 0 to 1 as positive correlation. Both CSI and MCSI are significant predictors of severity & clinical outcome in acute pancreatitis & has a correlation of significance with Ranson’s criteria, but the correlation is better with MCSI (r:0.53; p<0.01) as compared to the CSI (r:0.35;p:0.04). This study shows highly significant concordance between the MCSI score & prediction of multi organ failure, superadded infection, duration of hospital stay and mortality. However, the study shows low correlation by both the CT severity indices (CSI & MSCI) with regard to requirement of intervention. As compared to CSI, MCSI shows better correlation between the severity & clinical outcome parameters in acute pancreatitis.
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SAMPLING METHOD : Non-probability convenience sampling. SAMPLE SIZE : 80 N = (Z) 2 1-α * pq/d2 = (1.96)2 *(0.433)(0.567)/(0.11)2 =0.943155/ (0.11)2 =80 Z1- α/ α =1.96 at 5 % level of significance at 95% confidence interval. p = prevalence = 43.3 % [Reference article] q=1-p with 80 % power. OUTCOME VARIABLES : • Concordance of CT severity Index and Modified CT severity Index with the Ranson’s criteria score. • Sensitivity, specificity and positive predictive value will be calculated for CT Severity Index and Modified CT Severity Index. • Extent of association of CT Severity Index and Modified CT Severity Index with the clinical outcome parameters. DATA ANALYSIS PLAN : 1. The collected data will be analysed using the latest SPSS (Statistical Package for the Social Sciences) software. 2. Descriptive statistics – frequency and percentage/mean, standard deviation will be reported for all the required parameters. 3. Chi-square test as the basis to check association between difference of severity assessment. 4. Sensitivity, specificity and positive predictive value of desired parameters.