Correlation between admission laboratory values, early abdominal computed tomography, and severe complications of gallstone pancreatitis

Background: Our previous study demonstrated that Balthazar grade D or E pancreatitis on early abdominal computed tomography (CT) scan correlated with severe complications of gallstone pancreatitis (GP). Objective: To compare the efficacy of individual admission laboratory criteria, multiple criteria scoring systems and CT scan for predicting severe complications of GP. Methods: Consecutively admitted patients with GP underwent selective early CT scanning (<72 hours). All patients were prospectively monitored for severe complications. Results: Of the 66 patients studied, 21 (32%) did not undergo for early CT scanning and underwent cholecystectomy with no complications. Forty-five patients (68%) had an early abdominal CT scan. Of the 12 patients with grade E pancreatitis, 6 (50%) developed severe complications versus only 2 of 33 (6%) with grade A to D pancreatitis (P = 0.002). A significant correlation was found between admission white blood cell count ≥14.5 × 109/L and grade E pancreatitis on early CT scan (P = 0.002). However, admission glucose ≥150 mg/dL was the best predictor of complications (sensitivity 100%, negative predictive value 100%). Conclusions: Although Balthazar grade E on early CT scan correlates with severe complications of GP, admission glucose ≥150 mg/dL has a better sensitivity and negative predictive value, is quicker to use, and is more cost-effective as a prognostic indicator.