Application of the modified computed tomography severity index and retroperitoneal extension classification for evaluation of acute pancreatitis

Background: This study examined the clinical application of the modified computed tomography severity index (MCTSI) and retroperitoneal extension classification (REC) in the evaluation of acute pancreatitis (AP) among Vietnamese patients.Methods: Data from 115 patients with AP between January 2022 and February 2024 were retrospectively analyzed.AP was diagnosed using the revised Atlanta classification (RAC) criteria.All computed tomography images were assessed by two abdominal radiologists with over 10 years of experience.Patients with AP secondary to blunt abdominal trauma were excluded.Results: The mean patient age was 49.8 16.7 years, and the male:female ratio was 2.7:1.Necrotizing AP was observed in 24.3% of cases and extrapancreatic complications in 35.7%.Pancreatic and peripancreatic fluid collections were noted in 68.7% of cases, including 39.1% with acute peripancreatic fluid collection, 7.8% pseudocyst, 21.7% acute necrotic collection, and 4.3% walled-off necrosis.Based on MCTSI, the rates of mild, moderate, and severe AP were 28.7%, 53.9%, and 17.4%, respectively.Grades I, II, III, IV, and V REC represented 55.7%, 13.0%, 19.1%, 5.2%, and 7.0% of patients, respectively.MCTSI and REC were correlated with RAC in the evaluation of AP severity.Multivariate regression analysis revealed MCTSI to be an independent predictor of severe AP (odds ratio, 2.719; 95% confidence interval, 1.149-6.437;P = 0.023).MCTSI > 7 was the cutoff for predicting severe AP, with a sensitivity of 83.3%, specificity of 86.2%, and area under the curve of 0.944 (P < 0.001).Compared to the non-severe group, those with severe AP according to MCTSI had a longer hospitalization period (11 [9.25-16.75]days vs. 9 [6.50-12.00]days), a higher intensive care unit admission rate (30.0% vs. 3.2%), and greater mortality (15.0% vs. 1.1%).Conclusion: In the assessment of AP severity, MCTSI and REC were correlated with RAC.MCTSI was an independent predictor of severe AP.