Evaluation of diagnostic accuracy of modified computed tomography severity index in predicting severity of acute pancreatitis

Abstract

Objective: To compare the radiological scoring system  Modified Computed Tomography Severity Index (MCTSI) with clinical scoring of Bedside Index for Severity in Acute Pancreatitis (BISAP) in predicting Organ failure and severity in Acute Pancreatitis there by to evaluate the diagnostic accuracy of MCTSI.Methods: Patients of all the age groups, presenting with two or more features of pain in epigastrium radiating to back, serum lipase or amylase three times the normal limit and sonographic findings of acute pancreatitis were included. The clinical BISAP score and radiological MCTSI were calculated and compared by plotting ROC curve to calculate the diagnostic accuracy of MCTSI in predicting organ failure and severity.Results: The Age of the study group ranged from 10 to 75 years with mean age of 38 years. When MCTSI is more than or equal to 8 its sensitivity, specificity, Area Under Curve (AUC) and P-value is 81%, 79%, 0.856 and 0.000. MCTSI score ≤4 has sensitivity of 97%, specificity of 40%, AUC 0.86 for predicting no organ failure. MCTSI ≥4 (4-6) has a sensitivity of 96%, specificity of 31%, AUC of 0.65.Area under the receiver operating characteristic curve for the prediction of accuracy for persistent organ failure by MCTSI revealed that MCTSI score ≥8 has sensitivity of 100 %, specificity of 79%, AUC of 0.91 and for BISAP >2 has sensitivity of 87%, specificity of 87% and AUC of 0.81.Conclusion: Modified CT severity index is a simple scoring system and can be used for predicting severity of pancreatitis and organ failure more accurately.