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AJR Am J Roentgenol. 2018 Nov;211(5):1035-1043. doi: 10.2214/AJR.18.19545. Epub 2018 Aug 30.

Early Prediction of the Severity of Acute Pancreatitis Using Radiologic and Clinical Scoring Systems With Classification Tree Analysis.

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1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
2 Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
3 Department of Internal Medicine, College of Medicine, Chung-Ang University, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
4 College of Business, Korea Advanced Institute of Science and Technology, Seoul, Republic of Korea.



The objective of our study was to develop a decision tree model for the early prediction of the severity of acute pancreatitis (AP) using clinical and radiologic scoring systems.


For this retrospective study, 192 patients with AP who underwent CT 72 hours or less after symptom onset were divided into two cohorts: a training cohort (n = 115) and a validation cohort (n = 77). Univariate analysis was performed to identify significant parameters for the prediction of severe AP in the training cohort. For early prediction of disease severity, a classification tree analysis (CTA) model was constructed using significant scoring systems shown by univariate analysis. To assess the diagnostic performance of the model, we compared the area under the ROC curve (AUC) with each selected single parameter. We also evaluated the diagnostic performance in the validation cohort.


The Acute Physiology and Chronic Health Evaluation (APACHE)-II score, bedside index for severity in acute pancreatitis (BISAP) score, extrapancreatic inflammation on CT (EPIC) score, and Balthazar grade were included in the CTA model. In the training cohort, our CTA model showed a trend of a higher AUC (0.853) than the AUC of each single parameter (APACHE-II score, 0.835; BISAP score, 0.842; EPIC score, 0.739; Balthazar grade, 0.700) (all, p > 0.0125) while achieving specificity (100%) higher than and accuracy (94.8%) comparable to each single parameter (both, p < 0.0125). In the validation cohort, the CTA model achieved diagnostic performance similar to the training cohort with an AUC of 0.833.


Our CTA model consisted of clinical (i.e., APACHE-II and BISAP scores) and radiologic (i.e., Balthazar grade and EPIC score) scoring systems and may be useful for the early prediction of the severity of AP and identification of high-risk patients who require close surveillance.


acute pancreatitis; classification tree analysis; contrast-enhanced CT; early prediction; severe acute pancreatitis


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