Possibilities of ultrasonic diagnostics in prediction of the severity of acute pancreatitis

Abstract

INTRODUCTION: Acute pancreatitis is one of the most common emergency pathologies of the gastrointestinal tract. Currently, contrast-enhanced computed tomography is considered the method of choice for diagnosing, staging and detecting complications of acute pancreatitis, but early (72–96 hours from the onset of the disease) is recommended only if the diagnosis is unclear and differential diagnosis with other diseases. This role in the early stages of the disease can be performed by ultrasound diagnostics.OBJECTIVE: To assess the possibility of predicting the severity of acute pancreatitis using ultrasound signs.MATERIALS AND METHODS: Analyzed and compared the results of laboratory and physical methods of research, ultrasound, computed tomography in 319 patients with varying degrees of severity of acute pancreatitis.RESULTS: We assessed the impact of ultrasound signs on the likelihood of developing severe acute pancreatitis using binary logistic regression. Statistically significant are the following indicators: the presence of poorly demarcated fluid accumulation (p<0.001), the absence of visualization of the pancreas due to the phenomenon of aerocolia (p<0.001), the presence of free fluid in the abdominal cavity (p<0.001), the model using ultrasound data tended to be higher area under the ROC curve (AUC 0.789) compared with clinical prognostic systems: SOFA (AUC 0.686), APACHE-II (AUC 0.603), BISAP (AUC 0.619), Marshall (AUC 0.532). Computed tomography was performed in 15.67% of patients at various times, if indicated, according to clinical guidelines. When assessing the predictive ability of CT using the Baltazar scale, the area under the ROC curve was 0.85.CONCLUSION: Despite the fact that ultrasound diagnostics is somewhat inferior to computed tomography in prognostic efficiency, given the availability of the method, it is rational to use the ultrasound method for the purpose of early prediction of the severity of acute pancreatitis.