Added value of CT criteria compared to the clinical SAP score in patients with acute pancreatitis

Background: To assess the added value of established computed tomography (CT) scores versus the Simplified Acute Physiology (SAP) score in predicting outcome in patients with acute pancreatitis. Methods: Contrast-enhanced CT was performed in 45 patients with acute pancreatitis. The Balthazar score, CT severity index (CTSI), and Schr?der score were assessed, and the SAP score was calculated. The predictive values of CT score and SAP score for mortality, need for one or more interventions, and length of hospital stay were compared. The added value of the SAP score to the CT scores was assessed by using ROC (receiver operating curve) analysis. Results: The positive predictive values of the higher Balthazar, CTSI, Schr?der, and SAP scores, reflecting severe disease, were 50%, 41%, 41%, and 48%, respectively, for mortality, 85%, 84%, 84%, and 83%, respectively, for need for one or more interventions, and 55%, 66%, 66%, and 65%, respectively, for longer hospital stay. The negative predictive values of the lower Balthazar, CTSI, Schr?der and SAP scores were 84%, 92%, 92%, and 42%, respectively, for mortality, 44%, 69%, 69%, and 45%, respectively, for need for one or more interventions, and 44%, 69%, 69%, and 55%, respectively, for longer hospital stay. When CT scores were added to the SAP score, there was no improvement in discriminating power for mortality. Conclusion: To identify patients with severe outcome, there is no clear benefit using established CT scores as opposed to the SAP score. However, the Balthazar score and CTSI are better than the SAP score in predicting a favorable outcome. Received: 29 July 1997/Accepted: 10 September 1997