Computed tomography severity index vs. Other indices in the prediction of severity and mortality in acute pancreatitis: A predictive accuracy meta-analysis

Alexandra Mikó, Éva Vigh, Péter Mátrai, Alexandra Soós, András Garami, M. Balaskó, L. Czakó, Bernadett Mosdósi, Patrícia Sarlós, Bálint Erőss, Judit Tenk, Ildikó Rostás, P. Hegyi

Research output: Article

Abstract

Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73–0.86) for CTSI; 0.87 (CI 0.83–0.90) for BISAP; 0.80 (CI 0.72–0.89) for mCTSI; 0.73 (CI 0.66–0.81) for CRP level; 0.87 (CI 0.81–0.92) for the Ranson score; and 0.91 (CI 0.88–0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76–0.85) for CTSI; 0.79, (CI 0.72–0.86) for BISAP; 0.83 (CI 0.75–0.91) for mCTSI; 0.73 (CI 0.64–0.83) for CRP level; 0.81 (CI 0.75–0.87) for Ranson score and 0.80 (CI 0.77–0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

Original languageEnglish
Article number1002
JournalFrontiers in Physiology
Volume10
Issue numberAUG
DOIs
Publication statusPublished - jan. 1 2019

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Pancreatitis
Meta-Analysis
Tomography
Confidence Intervals
Mortality
C-Reactive Protein
Health
Area Under Curve
PubMed
Libraries
Necrosis
Software
Databases

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

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Computed tomography severity index vs. Other indices in the prediction of severity and mortality in acute pancreatitis : A predictive accuracy meta-analysis. / Mikó, Alexandra; Vigh, Éva; Mátrai, Péter; Soós, Alexandra; Garami, András; Balaskó, M.; Czakó, L.; Mosdósi, Bernadett; Sarlós, Patrícia; Erőss, Bálint; Tenk, Judit; Rostás, Ildikó; Hegyi, P.

In: Frontiers in Physiology, Vol. 10, No. AUG, 1002, 01.01.2019.

Research output: Article

Mikó, Alexandra ; Vigh, Éva ; Mátrai, Péter ; Soós, Alexandra ; Garami, András ; Balaskó, M. ; Czakó, L. ; Mosdósi, Bernadett ; Sarlós, Patrícia ; Erőss, Bálint ; Tenk, Judit ; Rostás, Ildikó ; Hegyi, P. / Computed tomography severity index vs. Other indices in the prediction of severity and mortality in acute pancreatitis : A predictive accuracy meta-analysis. In: Frontiers in Physiology. 2019 ; Vol. 10, No. AUG.
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abstract = "Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95{\%} confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73–0.86) for CTSI; 0.87 (CI 0.83–0.90) for BISAP; 0.80 (CI 0.72–0.89) for mCTSI; 0.73 (CI 0.66–0.81) for CRP level; 0.87 (CI 0.81–0.92) for the Ranson score; and 0.91 (CI 0.88–0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76–0.85) for CTSI; 0.79, (CI 0.72–0.86) for BISAP; 0.83 (CI 0.75–0.91) for mCTSI; 0.73 (CI 0.64–0.83) for CRP level; 0.81 (CI 0.75–0.87) for Ranson score and 0.80 (CI 0.77–0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.",
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TY - JOUR

T1 - Computed tomography severity index vs. Other indices in the prediction of severity and mortality in acute pancreatitis

T2 - A predictive accuracy meta-analysis

AU - Mikó, Alexandra

AU - Vigh, Éva

AU - Mátrai, Péter

AU - Soós, Alexandra

AU - Garami, András

AU - Balaskó, M.

AU - Czakó, L.

AU - Mosdósi, Bernadett

AU - Sarlós, Patrícia

AU - Erőss, Bálint

AU - Tenk, Judit

AU - Rostás, Ildikó

AU - Hegyi, P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73–0.86) for CTSI; 0.87 (CI 0.83–0.90) for BISAP; 0.80 (CI 0.72–0.89) for mCTSI; 0.73 (CI 0.66–0.81) for CRP level; 0.87 (CI 0.81–0.92) for the Ranson score; and 0.91 (CI 0.88–0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76–0.85) for CTSI; 0.79, (CI 0.72–0.86) for BISAP; 0.83 (CI 0.75–0.91) for mCTSI; 0.73 (CI 0.64–0.83) for CRP level; 0.81 (CI 0.75–0.87) for Ranson score and 0.80 (CI 0.77–0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

AB - Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73–0.86) for CTSI; 0.87 (CI 0.83–0.90) for BISAP; 0.80 (CI 0.72–0.89) for mCTSI; 0.73 (CI 0.66–0.81) for CRP level; 0.87 (CI 0.81–0.92) for the Ranson score; and 0.91 (CI 0.88–0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76–0.85) for CTSI; 0.79, (CI 0.72–0.86) for BISAP; 0.83 (CI 0.75–0.91) for mCTSI; 0.73 (CI 0.64–0.83) for CRP level; 0.81 (CI 0.75–0.87) for Ranson score and 0.80 (CI 0.77–0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

KW - Accuracy

KW - Acute pancreatitis

KW - CT-severity index

KW - Mortality

KW - Severity

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