Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 73

The prognostic significance of parenchymal and extra‐parenchymal injury was first illustrated in 1985 by Balthazar et al. [73]. These authors demonstrated that the degree of edema, and number of pancreatic fluid collections, determined the risk of infection of pancreatic fluid collections and death in 83 patients with acute pancreatitis. Subsequently, presence and degree of pancreatic parenchymal necrosis were recognized to be significant predictors of morbidity and mortality [74]. The most commonly recognized cross‐sectional imaging‐driven prediction tools are computed tomography severity index (CTSI) and modified CTSI. These depend on the availability of contrast‐enhanced CT and assess severity by degree of pancreatic edema and pancreatic collections, as well as presence and extent of parenchymal necrosis (Table 4.3). It is worth noting that pancreatic fluid collections (necrotic and non‐necrotic) are not independent mediators of mortality unless they become infected [4]. On the other hand, the degree of parenchymal and extra‐parenchymal injury strongly correlates with both inpatient and outpatient morbidity [75,76]. This is not surprising because morbidity from acute pancreatitis is determined by the compressive effects of fluid collections on surrounding organs or infection of the collections.