Early Predictors of Necrosis in Patients Presenting With Edematous Acute Pancreatitis: Prospective Validation of the...

Accurate prediction of pancreatic necrosis remains critical in acute pancreatitis. This study aimed to identify early predictors of necrosis and externally validate the previously derived Necrosis Development Score-48 (NDS-48).

This prospective cohort study included patients with edematous acute pancreatitis confirmed by contrast-enhanced CT. Patients were followed for 3-6 months to monitor necrosis development, and associated factors were identified. The predictive performance of NDS-48 was evaluated, and cumulative probabilities by risk category were estimated using Kaplan-Meier analyses. Sensitivity analyses assessed the robustness of the findings.

Necrosis developed in 39 (15.9%) of 246 patients during follow-up. Of these, 27 (69.2%) had walled-off necrosis and 11 (28.2%) had infected pancreatic necrosis. White blood cell count, lactate dehydrogenase, C-reactive protein, and albumin at 48 h were significant predictors, forming the basis of the modified NDS-48. The area under the curve for NDS-48 and modified NDS-48 was 0.947 (95% CI, 0.918-0.976) and 0.965 (0.942-0.988), respectively. Necrosis occurred in only one low-risk patient, while over three-quarters of high-risk patients developed necrosis. Sensitivity analyses yielded similar results.

NDS-48 and its modified version demonstrated excellent diagnostic accuracy for predicting necrosis and allow early risk stratification in patients with edematous acute pancreatitis.