The Modified Pancreatitis Activity Scoring System Shows Distinct Trajectories in Acute Pancreatitis: An International Study
Por:
Paragomi, Pedram, Hinton, Alice, Pothoulakis, Ioannis, Talukdar, Rupjyoti, Kochhar, Rakesh, Goenka, Mahesh K., Gulla, Aiste, Gonzalez, Jose A., Singh, Vikesh K., Bogado, Miguel Ferreira, Stevens, Tyler, Barbu, Sorin T., Nawaz, Haq, Gutierrez, Silvia C., Zarnescu, Narcis, Archibugi, Livia, Easler, Jeffrey J., Triantafyllou, Konstantinos, Pelaez-Luna, Mario, Thakkar, Shyam, Ocampo, Carlos, de-Madaria, Enrique, Cote, Gregory A., Lee, Peter J., Krishna, Somashekar, Lara, Luis F., Han, Samuel, Wu, Bechien U., Papachristou, I, Georgios
Publicada:
1 ene 2022
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. © 2022 AGA Institute
Filiaciones:
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, United States
Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
MedStar Washington Hospital Center, District of Columbia, Washington
Asian Gastroenterology Institute, Hyderabad, India
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Apollo Gleneagles Hospitals Kolkata, Kolkata, India
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Georgetown University Hospital, Washington, DC, United States
Universidad Autónoma de Nueva León, Monterrey, Mexico
Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, MA, United States
Hospital Nacional de Itauguá, Itaugua, Paraguay
Cleveland Clinic, Cleveland, Ohio, United States
University of Medicine and Pharmacy “Iuliu Hatieganu,” Cluj-Napoca, Romania
Eastern Maine Medical Center, Maine, Bangor
Hospital Nacional “Profesor Alejandro Posadas,” Buenos Aires, Argentina
University of Medicine and Pharmacy, Bucharest, Romania
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
Indiana University School of Medicine, Indianapolis, IN, United States
Attikon University General Hospital, Athens, Greece
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico
Division of Gastroenterology, West Virginia University, Morgantown, WV, United States
Hospital General de Argudos “Dr. Cosme Argerich,” Buenos Aires, Argentina
Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
Medical University of South Carolina, Charleston, South Carolina, United States
Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Pennsylvania, Philadelphia
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
Kaiser Permanente, Los Angeles, California, United States
Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA
Univ Pittsburgh, Med Ctr, Hillman Canc Ctr, Pittsburgh, PA USA
Ohio State Univ, Coll Publ Hlth, Div Biostat, Columbus, OH 43210 USA
MedStar Washington Hosp Ctr, Washington, DC USA
Asian Gastroenterol Inst, Hyderabad, India
Postgrad Inst Med Educ & Res, Chandigarh, India
Apollo Gleneagles Hosp Kolkata, Kolkata, India
Vilnius Univ, Fac Med, Inst Clin Med, Vilnius, Lithuania
Georgetown Univ Hosp, Washington, DC 20007 USA
Univ Autonoma Nueva Leon, Monterrey, Mexico
Johns Hopkins Med Inst, Div Gastroenterol, Baltimore, MA USA
Hosp Nacl Itaugua, Itaugua, Paraguay
Cleveland Clin, Cleveland, OH 44106 USA
Univ Med & Pharm Iuliu Hatieganu, Cluj Napoca, Romania
Eastern Maine Med Ctr, Bangor, ME USA
Hosp Nacl Prof Alejandro Posadas, Buenos Aires, DF, Argentina
Univ Med & Pharm, Bucharest, Romania
San Raffaele Sci Inst IRCCS, Pancreas Translat & Clin Res Ctr, Pancreatobiliary Endoscopy & Endosonog Div, Milan, Italy
St Andrea Hosp, Digest & Liver Dis Unit, Rome, Italy
Indiana Univ Sch Med, Indianapolis, IN 46202 USA
Attikon Univ Gen Hosp, Athens, Greece
Univ Autonoma Mexico, Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico
West Virginia Univ, Div Gastroenterol, Morgantown, WV 26506 USA
Hosp Gen Argudos Dr Cosme Argerich, Buenos Aires, DF, Argentina
Alicante Univ Gen Hosp, Gastroenterol Dept, ISABIAL, Alicante, Spain
Med Univ South Carolina, Charleston, SC 29425 USA
Hosp Univ Penn, Dept Med, Div Gastroenterol, Philadelphia, PA 19104 USA
Papachristou, Georgios, I, Ohio State Univ, Wexner Med Ctr, Div Gastroenterol Hepatol & Nutr, Columbus, OH 43210 USA
Kaiser Permanente, Los Angeles, CA USA
|