Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis

Background: Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear. Methods: The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups: the early CT group (CT done at 4–5 days after the onset of pain) and the late CT group (CT done in days 6–14 following onset of pain). The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT, such as detection of pancreatic necrosis and local complications, and CT severity index. Results: Of 214 patients [143 (66.8%) males; mean age 39.87 ± 13.52 years], 21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP. The early CT group included 114 patients, whilst the late CT group had 79. The mean CT severity index was higher in the late CT group (6.65 ± 2.27 vs. 5.52 ± 2.7; P = 0.005). The incidence of persistent organ failure in the early group was no different from that of the late group (38.6% vs. 49.4%; P = 0.143). Local complications were detected more often in the late CT group (84.8% vs. 68.4%; P = 0.011). There was no difference between the two groups in the need for percutaneous drainage, surgery, or mortality (all P > 0.05). Conclusions: Although performing early CT does not adversely affect the outcome in AP, CT carried out more than 5 days after the onset of symptoms may detect more local complications.