Pancreatic necrosis volume – A new imaging biomarker of acute pancreatitis severity

•Pancreatic necrosis volume was significantly correlated with AP complications.•The average time spent on calculating the necrosis volume in the CT studies was less than 5 min.•A necrosis volume of 75 cc proved to be an optimal threshold value to predict complications such as infection or need for surgical procedures.•Pancreatic necrosis volume was compared with other scoring systems (BISAP score, CRP, CT severity index and Balthazar score).•The area under the ROC curve showed that pancreatic necrosis volume was the most accurate parameter to predict complications. Determine if the pancreatic necrosis volume (PNV) in computed tomography scan (CT) is a useful marker to predict the severity of acute pancreatitis (AP) comparing its predictive value with current clinical scoring systems. This retrospective study was conducted in a tertiary hospital, including patients hospitalized with AP during the period of 24 months. Demographic, clinical data, length of hospital stay and analytical parameters were collected from the hospital clinical information digital systems. Other information on the severity of the disease was also reviewed, including BISAP score, organ failure (OF) or admission to the ICU, as well as, complications during hospitalization as infected necrotic collections, surgical procedure or death. The quantification of the necrosis volume, CT severity index and Balthazar score were assessed in the CT studies. ROC curves were carried to compare the correlation between different scoring systems and the acute complications. This study included 163 patients with AP. The calculated average value of PNV in the CT studies was 242 cc (0–1575 cc). PNV showed lineal correlation with hospital stay (Pearson 0.696) and statistically significant association with acute complications as OF, multiple organ failure, infection, need of treatment or hospitalization at ICU (P