Computed Tomography Assessment of Severity of Acute Pancreatitis in Bangladeshi Children
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Acute pancreatitis (AP) is common among children in Bangladesh. Its management depends mainly on risk stratification. This study aimed to assess the severity of pediatric AP using computed tomography (CT). Methods: This cross-sectional, descriptive study was conducted in pediatric patients with AP at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh. Results: Altogether, 25 patients with AP were included, of whom 18 (mean age, 10.27±4.0 years) were diagnosed with mild AP, and 7 (mean age, 10.54±4.0 years) with severe AP. Abdominal pain was present in all the patients, and vomiting was present in 88% of the patients. Etiology was not determined. No significant differences in serum lipase, serum amylase, BUN, and CRP levels were observed between the mild and severe AP groups. Total and platelet counts as well as hemoglobin, hematocrit, serum creatinine, random blood sugar, and serum alanine aminotransferase levels (p>0.05) were significantly higher in the mild AP group than in the severe AP group (p=0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of CT severity index (CTSI) were 71.4%, 72.2%, 50%, and 86.7%, respectively. In addition, significant differences in pancreatic appearance and necrosis were observed between the two groups on CT. Conclusion: CT can be used to assess the severity of AP. In the present study, the CTSI effectively assessed the severity of AP in pediatric patients.
Abstract
Purpose: Acute pancreatitis (AP) is common among children in Bangladesh. Its management depends mainly on risk stratification. This study aimed to assess the severity of pediatric AP using computed tomography (CT). Methods: This cross-sectional, descriptive study was conducted in pediatric patients with AP at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh. Results: Altogether, 25 patients with AP were included, of whom 18 (mean age, 10.27±4.0 years) were diagnosed with mild AP, and 7 (mean age, 10.54±4.0 years) with severe AP. Abdominal pain was present in all the patients, and vomiting was present in 88% of the patients. Etiology was not determined. No significant differences in serum lipase, serum amylase, BUN, and CRP levels were observed between the mild and severe AP groups. Total and platelet counts as well as hemoglobin, hematocrit, serum creatinine, random blood sugar, and serum alanine aminotransferase levels (p>0.05) were significantly higher in the mild AP group than in the severe AP group (p=0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of CT severity index (CTSI) were 71.4%, 72.2%, 50%, and 86.7%, respectively. In addition, significant differences in pancreatic appearance and necrosis were observed between the two groups on CT. Conclusion: CT can be used to assess the severity of AP. In the present study, the CTSI effectively assessed the severity of AP in pediatric patients.
참고문헌 (24)
- Bai HX, "What have we learned about acute pancreatitis in children?", J Pediatr Gastroenterol Nutr, 52, pp.262~270 (2011)
- Lankisch PG, "Acute pancreatitis : does gender matter?", Dig Dis Sci, 46, pp.2470~2474 (2001)
- Lerch MM, "Models of acute and chronic pancreatitis", Gastroenterology, 144, pp.1180~1193 (2013)
- Yoon SB, "Impact of fatty liver on acute pancreatitis severity", Gastroenterol Res Pract, 2017, pp.4532320~ (2017)
- Abu-El-Haija M, "Classification of acute pancreatitis in the pediatric population: clinical report From the NASPGHAN Pancreas Committee", J Pediatr Gastroenterol Nutr, 64, pp.984~990 (2017)
- Shelton C, "GeneReviews®" (1993), University of Washington
- Chang JWY, "Diagnosing acute pancreatitis : amylase or lipase?", Hong Kong J Emerg Med, 18, pp.20~25 (2011)
- Szabo FK, "Early enteral nutrition and aggressive fluid resuscitation are associated with improved clinical outcomes in acute pancreatitis", J Pediatr, 167, pp.397~402 (2015)
- Lautz TB, "Acute pancreatitis in children : spectrum of disease and predictors of severity", J Pediatr Surg, 46, pp.1144~1149 (2011)
- Werner J, "Useful markers for predicting severity and monitoring progression of acute pancreatitis", Pancreatology, 3, pp.115~127 (2003)
- Balthazar EJ, "Acute pancreatitis : prognostic value of CT", Radiology, 156, pp.767~772 (1985)
- Balthazar EJ, "Complications of acute pancreatitis : clinical and CT evaluation", Radiol Clin North Am, 40, pp.1211~1227 (2002)
- Morinville VD, "Definitions of pediatric pancreatitis and survey of present clinical practices", J Pediatr Gastroenterol Nutr, 55, pp.261~265 (2012)
- Nydegger A, "Changing incidence of acute pancreatitis : 10-year experience at the Royal Children's Hospital, Melbourne", J Gastroenterol Hepatol, 22, pp.1313~1316 (2007)
- Musabbir N, "Liver involvement in Langerhans’ cell histiocytosis a case report", North Int Med Coll J, 7, pp.158~160 (2016)
- Vitale DS, "Blood urea nitrogen elevation is a marker for pediatric severe acute pancreatitis", Pancreas, 48, pp.363~366 (2019)
- Galai T, "Young age predicts acute pancreatitis severity in children", J Pediatr Gastroenterol Nutr, 68, pp.720~726 (2019)
- Pezzilli R, "Acute pancreatitis in children. An Italian multicentre study", Dig Liver Dis, 34, pp.343~348 (2002)
- Farrell PR, "Who’s at risk? A prognostic model for severity prediction in pediatric acute pancreatitis", J Pediatr Gastroenterol Nutr, 71, pp.536~542 (2020)
- Peng T, "Serum calcium as an indicator of persistent organ failure in acute pancreatitis", Am J Emerg Med, 35, pp.978~982 (2017)
- Izquierdo YE, "Multivariate model for the prediction of severity of acute pancreatitis in children", J Pediatr Gastroenterol Nutr, 66, pp.949~952 (2018)
- Lautz TB, "Utility of the computed tomography severity index(Balthazar score)in children with acute pancreatitis", J Pediatr Surg, 47, pp.1185~1191 (2012)
- Fabre A, "Severity scores in children with acute pancreatitis", J Pediatr Gastroenterol Nutr, 55, pp.266~267 (2012)
- Hashimoto N, "Efficacy of pediatric acute pancreatitis scores at a Japanese tertiary center", Pediatr Int, 58, pp.224~228 (2016)