Peritoneal cavity circumference on computed tomography predicts outcomes in acute pancreatitis.

Abstract Objectives We investigated the role of novel intra-abdominal parameters measured by computed tomography (CT) in the prediction of clinical outcomes in acute pancreatitis (AP). Methods Patients with AP underwent an abdominal CT scan on admission to define different intra-abdominal parameters (abdominal circumference, peritoneal cavity circumference, intraabdominal visceral fat area, and subcutaneous fat area) at the L2-L3 level using the open-source image analysis software Osirix Lite v.11.0.4 to predict clinical outcomes. Results Eighty patients with AP were analyzed. Peritoneal cavity circumference (PCC) was the only variable independently associated with outcomes. PCC showed an area under ROC for prediction of severity in AP of 0.830. A PCC ≥ 85 cm increased the risk of severity of AP (RR 15.71), persistent systemic inflammatory response syndrome (RR 9.33), acute peripancreatic fluid collection (RR 6.36), necrotizing pancreatitis (RR 21.5), and mortality (RR 2.42). We found a 4.7-fold increase in the risk of developing severe AP for each 10 cm increase in PCC. Conclusions PCC measurement at the L2-L3 level using a non-enhanced abdominal CT scan on admission in patients with AP is useful in the early prediction of severity, persistent systemic inflammatory response syndrome, local complications, and mortality.