The Modified Pancreatitis Activity Scoring System Shows Distinct Trajectories in Acute Pancreatitis: An International Study.
Por:
Paragomi P, Hinton A, Pothoulakis I, Talukdar R, Kochhar R, Goenka MK, Gulla A, Gonzalez JA, Singh VK, Bogado MF, Stevens T, Barbu ST, Nawaz H, Gutierrez SC, Zarnescu N, Archibugi L, Easler JJ, Triantafyllou K, Peláez-Luna M, Thakkar S, Ocampo C, Enrique de-Madaria, Cote GA, Lee PJ, Krishna S, Lara LF, Han S, Wu BU and Papachristou GI
Publicada:
1 jun 2022
Ahead of Print:
17 sep 2021
Resumen:
BACKGROUND & AIMS: The aims of this study were to: (1) assess the performance of the Pancreatitis Activity Scoring System (PASS) in a large intercontinental cohort of patients with acute pancreatitis (AP); and (2) investigate whether a modified PASS (mPASS) yields a similar predictive accuracy and produces distinct early trajectories between severity subgroups. METHODS: Data was prospectively collected through the Acute Pancreatitis Patient Registry to Examine Novel Therapies In Clinical Experience (APPRENTICE) consortium (2015-2018) involving 22 centers from 4 continents. AP severity was categorized per the revised Atlanta classification. PASS trajectories were compared between the three severity groups using the generalized estimating equations model. Four mPASS models were generated by modifying the morphine equivalent dose (MED), and their trajectories were compared. RESULTS: A total of 1393 subjects were enrolled (median age, 49 years; 51% males). The study cohort included 950 mild (68.2%), 315 (22.6%) moderately severe, and 128 (9.2%) severe AP. Mild cases had the lowest PASS at each study time point (all P < .001). A subset of patients with outlier admission PASS values was identified. In the outlier group, 70% of the PASS variation was attributed to the MED, and 66% of these patients were from the United States centers. Among the 4 modified models, the mPASS-1 (excluding MED from PASS) demonstrated high performance in predicting severe AP with an area under the receiver operating characteristic curve of 0.88 (vs area under the receiver operating characteristic of 0.83 in conventional PASS) and produced distinct trajectories with distinct slopes between severity subgroups (all P < .001). CONCLUSION: We propose a modified model by removing the MED component, which is easier to calculate, predicts accurately severe AP, and maintains significantly distinct early trajectories.
Filiaciones:
Paragomi P:
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
Hinton A:
Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
Pothoulakis I:
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
MedStar Washington Hospital Center, Washington, District of Columbia
Talukdar R:
Asian Gastroenterology Institute, Hyderabad, India
Kochhar R:
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Goenka MK:
Apollo Gleneagles Hospitals Kolkata, Kolkata, India
Gulla A:
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Georgetown University Hospital, Washington DC
Gonzalez JA:
Universidad Autónoma de Nueva León, Monterrey, Mexico
Singh VK:
Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, MA
Bogado MF:
Hospital Nacional de Itauguá, Itauguá, Paraguay
Stevens T:
Cleveland Clinic, Cleveland, Ohio
Barbu ST:
University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania
Nawaz H:
Eastern Maine Medical Center, Bangor, Maine
Gutierrez SC:
Hospital Nacional "Profesor Alejandro Posadas," Buenos Aires, Argentina
Zarnescu N:
University of Medicine and Pharmacy, Bucharest, Romania
Archibugi L:
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
Digestive and Liver Disease Unit, Sant'Andrea Hospital, Rome, Italy
Easler JJ:
Indiana University School of Medicine, Indianapolis, Indiana
Triantafyllou K:
Attikon University General Hospital, Athens, Greece
Peláez-Luna M:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico
Thakkar S:
Division of Gastroenterology, West Virginia University, Morgantown, West Virginia
Ocampo C:
Hospital General de Argudos "Dr. Cosme Argerich," Buenos Aires, Argentina
:
Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
Cote GA:
Medical University of South Carolina, Charleston, South Carolina
Lee PJ:
Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Krishna S:
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
Lara LF:
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
Han S:
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
Wu BU:
Kaiser Permanente, Los Angeles, California
Papachristou GI:
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio
Green Accepted
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