To compare acute kidney injury (AKI) frequency and clinical outcomes in patients with necrotizing acute pancreatitis (AP) undergoing non-contrast computed tomography (NCCT) with those undergoing contrast-enhanced CT (CECT) during hospitalization.

This prospective randomized controlled trial was registered in the trial registry. The institute ethics committee approved the protocol of the trial. Written informed consent was obtained from the patients or their kin. Patients aged 12-70 years with AP who presented to the hospital within five days of pain onset were included. The diagnosis of AP was based on the revised Atlanta classification (RAC) (2). All patients underwent baseline CECT between 5 and 7 days of pain onset. Patients who had necrotizing AP on CECT scan done between 5 and 7 days from the date of pain onset were considered for inclusion if they required one or more CT scans beyond 1^st week of illness during their treatment while hospitalized as per clinical indication. Patients who already underwent CECT beyond 1^st week of disease were excluded. Also, pregnant patients, those with a history of...

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Patients

One hundred and eighty-four patients with AP were assessed for eligibility. Necrotizing AP was diagnosed in 138 patients. Eight patients had acute on chronic pancreatitis. Two were found to have chronic kidney disease. Two patients were pregnant, and six did not consent to inclusion in the study. Finally, 120 patients (82 males, median age 35 years, IQR: 28-47 years) were randomized to NCCT and CECT groups. 

Figure 1 shows the patient enrollment and randomization. Of the patients allocated to the NCCT group, 13 patients received CECT after at least one NCCT [due to suspicion of hemorrhagic complications (n=6), inadequate evaluation of the collections by NCCT (n=3), and assessment of intervention (percutaneous or endoscopic drainage) related complications (n=3)] and two patients died before the completion of the protocol. Hence,...

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Patients with necrotizing AP undergoing CECT have a higher incidence of AKI and worse outcomes compared to those undergoing NCCT. However, after adjusting for the severity of AP, the incidence of new AKI and clinical outcomes were comparable in both groups.