Early Predictors of Necrosis in Patients Presenting With Edematous Acute Pancreatitis: Prospective Validation of the Necrosis Development Score‐48 ( NDS ‐48)

BACKGROUND/AIM: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: NDS-48 and its modified version demonstrated excellent diagnostic accuracy for predicting necrosis and allow early risk stratification in patients with edematous acute pancreatitis.