Effects of early contrast-enhanced computed tomography on clinical course and complications in patients with acute pancreatitis

Abstract

Purpose: To investigate the effect of an early contrast-enhanced computed tomography (CECT) on clinical course and complications of acute pancreatitis (AP).

Material and Methods: 58 patients with AP who had at least one CECT examination were analyzed retrospectively. Laboratory as well as clinical data, and results from the assessment of disease severity (CT severity index (CTSI) and its modified (MCTSI) version) were analyzed. The primary endpoint was the development of severe complications, defined as death, respiratory failure, acute renal failure, and the need for invasive interventions. Patients were divided into two groups: an early group (CECT within the first 48 h after the onset of symptoms, n = 32) and a late group (CECT > 48 h after the onset of symptoms, n = 26). Multivariate regression analysis was performed to identify risk factors for severe complications.

Results: There were no statistically significant differences between both groups concerning baseline characteristics, CTSI, and MCTSI. Complications occurred more often in the early CECT group (p = 0.008). Multivariate logistic regression analysis identified an early CECT and a severe MCTSI as independent risk factors for the occurrence of severe complications (p = 0.02 and p = 0.002, respectively).

Conclusion: CECT performed within the first 48 h after the onset of symptoms is associated with an unfavorable outcome in AP.

Zusammenfassung

Ziel: Es sollte der Einfluss einer frühzeitigen Computertomografie mit Kontrastmittelgabe (CECT) auf den klinischen Verlauf und Komplikationen bei akuter Pankreatitis (AP) untersucht werden.

Material und Methoden: Retrospektiv wurden 58 Patienten mit AP analysiert, für die mindestens eine CECT-Untersuchung im Krankenblatt dokumentiert war. Es wurden die Laborwerte, klinischen Daten und Ergebnisse der computertomografischen Erfassung des Schweregrads (Balthazar Score (CTSI) und dessen modifizierte (MCTSI) Version) ausgewertet. Als primärer Studienendpunkt war die Entwicklung schwerer Komplikationen definiert, nämlich Tod, Beatmungspflichtigkeit, Nierenversagen und die Notwendigkeit invasiver Interventionen. Je nach Zeitpunkt des CECT wurden die Patienten 2 Gruppen zugeteilt: frühe Gruppe (CECT innerhalb der ersten 48 Stunden nach Symptombeginn) und späte Gruppe (CECT > 48 Stunden nach Symptombeginn). Risikofaktoren für schweren Komplikationen wurden mithilfe einer multivariaten Regressionsanalyse identifiziert.

Ergebnisse: Die beiden Patientengruppen unterschieden sich zum Zeitpunkt der Eingangsuntersuchung nicht in Hinsicht auf die prognostisch relevanten Laborwerte, klinischen Daten, den CTSI oder MCTSI. Komplikationen wurden häufiger in der frühen Gruppe beobachtet (p = 0,008). Ein frühes CECT (p = 0,02) und ein hoher MCTSI (p = 0,002) wurden in der multivariaten Regressionsanalyse als Risikofaktoren für das Auftreten schwerer Komplikationen identifiziert.

Schlussfolgerung: Die Durchführung eines CECT innerhalb der ersten 48 Stunden nach Symptombeginn ist mit einem ungünstigen Verlauf der AP verbunden.

Schlüsselwörter

akute Pankreatitis - Komplikationen - Krankheitsverlauf - Computertomografie

Key words

acute pancreatitis - complications - clinical outcome - contrast-enhanced computed tomography

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