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Asociación Mexicana de Gastroenterología

2007, Number 2

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Rev Gastroenterol Mex 2007; 72 (2)

Value of clinical criteria to indicate a CT-FNA in the diagnosis of infected acute pancreatitis

González-González JA, Calderón-Lozano IE, Maldonado-Garza H, Mendoza-Fuerte E, Garza-Galindo AA, García-Cantú DA

Language: English
References: 36
Page: 104-112
PDF size: 67.06 Kb.


ABSTRACT

Objective: To assess the value of clinical criteria in detecting pancreatic infection (PI) on or after the seventh day of acute pancreatitis attack (AP). Methods: We determined as clinical criteria of suspicion of PI (SPI): the presence, persistence or recurrence of fever ≥ 38 °C, leukocytosis ≥ 12,000/mm3 and organ failure (OF) in the absence of extrapancreatic infection. Patients with SPI criteria underwent computed tomography - fine needle aspiration (CT-FNA), if CT-FNA was negative and SPI criteria for 72 hours CT-FNA was repeated. Results: We prospectively studied 369 patients with AP and found 48 patients who met SPI criteria (mean age 37 yr, 17-70 yr), 30 male and 18 female. Etiology was biliary (56.2%), alcohol (35.4%) and others (8.4%). We performed 53 CT-FNA in 48 patients and 28 were diagnosed with PI. At the time of CT-FNA 50% of patients had OF. Mean time for CT-FNA in patients with PI was 12.5 ± 7 days. Mean clinical follow-up after hospital discharge was one month. No patients with SPI criteria and negative CT-FNA or patients with-out SPI criteria developed clinical signs of PI. The SPI criteria had a sensitivity of 100%, specificity of 94% (CI 95% 92-97), PPV of 58% (IC 95% 44-72) and NPV of 100%. Conclusions: The application of SPI criteria on or after the seventh day of onset of AP can be a useful tool in making the decision and defining the time to perform a CT-FNA in order to clarify the clinical scenario between SIRS and sepsis related PI. Our approach can lead to better strategic treatments in the management of these difficult cases.


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