A study to evaluate the role of c- reactive protien, blood urea nitrogen and multislice computed tomography as early predictors of severity of acute pancreatitis

Introduction:- Acute pancreatitis is a clinical challenge, often requiring management in the critical care unit. Therefore, prediction of severity in early part of acute pancreatitis can be helpful in the better management of the case besides clinical examination, biochemical tests, multiple prognostic scoring systems and computed tomography (CT )have been used in the assessment of severity.
Material and methods:-This prospective study had been conducted in Department of Surgery in collaboration with Department of Radiodiagnosis, VMMC and SAFDARJUNG HOSPITAL between october, 2014 to April,2016. It aimed at evaluating the role of Blood Urea Nitrogen, C- reactive protein (CRP) and CECT scan as markers of early prediction of severity of acute pancreatitis. A total of 30 patients of both the sexes who presented with a clinical diagnosis of acute pancreatitis within 6 hours of onset of symptoms were included in the study.
Results:- CECT scan done between the 3rd to 5th day of presentation had the highest sensitivity and specificity (100% and 91.67% respectively) as an early marker of prediction of severity of acute pancreatitis.(p=0.500,Mc Nemar Bowker test and p value <0.001, kappa statistics).
CRP levels done at 24 hrs was also found to be a good marker of early prediction of severity of acute pancreatitis (sensitivity 100% and specificity 91.67%; p=0.001, Kruskall Wallis test).
CRP done at 6 and 36 hrs had a low sensitivity and specificity as early markers of prediction of severity of acute pancreatitis.BUN at 24 and 48 hrs had a low sensitivity and specificity as early markers of prediction of severity of acute pancreatitis.Combined together, CRP and CECT scan done within 72 hrs of clinical presentation had sensitivity and a specificity approaching close to 100% in predicting the severity of acute pancreatitis.
Conclusion:- CRP and CECT scan can act as good early predictor of severity of acute pancreatitis, done within the first 72 hrs of presentation and can aid the treating clinician in making early decision in critical care management of these patients.