Copyright @ Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Computed Tomography Versus Acute Physiology and Chronic Health Evaluation II Score in Predicting Severity of Acute Pancreatitis A Prospective, Comparative Study With Statistical Evaluation Charikleia Triantopoulou, MD, PhD,* Dimitrios Lytras, MD, PhD,Þ Petros Maniatis, MD, PhD,* Dimitrios Chrysovergis, MD,* Konstantinos Manes, MD,Þ Ioannis Siafas, MD,* John Papailiou, MD, PhD,* and Christos Dervenis, MD, PhDÞ Objective: The aim of the study was to compare Acute Physiology and Chronic Health Evaluation II score and C-reactive protein as a clinical index and computed tomographyYbased severity index (CTSI) in predicting the course of acute pancreatitis. Methods: One hundred forty-eight patients with acute pancreatitis were enrolled in the study during a 2-year period. All data con- cerning etiology, Atlanta classification, CT findings, Acute Physiol- ogy and Chronic Health Evaluation score, C-reactive protein levels, stay in the intensive care unit, length of hospital stay, treatment, complications, and deaths were analyzed with Mann-Whitney U, Wilcoxon, Pearson, and Spearman statistical tests. The CT was performed on a spiral unit after intravenous administration of con- trast material. Images were graded according to the Balthazar-CTSI scoring system. Results: A very good correlation was noticed between Balthazar- CTSI scores and local complications, whereas no statistically signi- ficant correlation was found between CT scores and stay in the intensive care unit. Among survivors and nonsurvivors, there were no statistically significant differences as far as CT scores were concerned. Conclusions: Although the extent of necrosis as defined on contrast- enhanced CT examinations is considered as a risk factor for a negative prognosis, our findings suggest that the initially documen- ted disease severity according only to imaging parameters is not highly important for the final patient outcome. Key Words: acute pancreatitis, computed tomography, APACHE score, CTSI (Pancreas 2007;35:238Y242) A cute pancreatitis (AP) is a common disease, with a re- ported incidence as high as 40 per 100,000 of the general population. 1 Approximately 20% to 30% of cases experience a severe attack resulting in high mortality rates due to multiorgan dysfunction syndrome either early in the course of the disease or late after development of septic complications. Prognostic evaluation of AP and assessment of severity is a key step in the management of the disease immediately after diagnosis and imaging modalities play a significant role toward this goal. The introduction of contrast-enhanced com- puted tomography (CECT) and the evolution of Balthazar and Computed Tomography Severity Index (CTSI) grading systems in the 1990s have greatly improved the initial eval- uation of patients with AP, becoming an essential part in the diagnostic workup of these patients. 2,3 On the other hand, several multifactorial scoring systems based on clinical and laboratory parameters (Ranson, Imrie, Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology [SAP]) have been developed and applied in an effort to reliably identify severe cases of AP. The APACHE II score, despite relative complexity and limited positive predictive value for severity, is considered the scoring system of choice for AP and has been widely used in clinical practice. 4,5 The role of CT as staging modality and prognostic tool early in the course of AP has been extensively studied so far, but the reported results are still controversial. The aim of our study was to evaluate the correlation between CT scoring systems (Balthazar, CTSI) and the APACHE II score in as- sociation with the clinical course and final outcome of patients with AP. MATERIALS AND METHODS One hundred forty-eight consecutive patients (76 men and 72 women; age range, 22Y95 years; mean age, 53 years) with a first episode of AP developed within 96 hours before hospital admission from January 2004 to January 2006 were prospectively enrolled in the study. Acute pancreatitis was defined as abdominal pain associated with serum amylase of greater than 450 IU/L. Patients with recurrent episodes of AP were not included in the study. All patients underwent contrast-enhanced CT within 96 hours after onset of symptoms. The examinations were conducted on a single row detector spiral unit (Prospeed; General Electric Medical Systems, Milwaukee, Wis) using the following parameters: kV 120, mA 160, time per rotation of the tube 1 second, and pitch 1. Unenhanced images were ORIGINAL ARTICLE 238 Pancreas & Volume 35, Number 3, October 2007 Received for publication September 28, 2006; accepted March 22, 2007. From the *Computed Tomography Department and †First Surgery Depart- ment, Konstantopoulio Agia Olga Hospital, Athens, Greece. Reprints: Charikleia Triantopoulou, MD, PhD, Pindos Square, Koritsas St, 15452 Athens, Greece (e-mail: chatri@mycosmos.gr; chatri@otenet.gr). Copyright * 2007 by Lippincott Williams & Wilkins