The Modified Pancreatitis Activity Scoring System Shows Distinct Trajectories in Acute Pancreatitis: An International Study.

Autor:	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, Itaugua, 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., Enrique de-Madaria; 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. Electronic address: georgios.papachristou@osumc.edu.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2022 Jun; Vol. 20 (6), pp. 1334-1342.e4. Date of Electronic Publication: 2021 Sep 17.
DOI:	10.1016/j.cgh.2021.09.014
Abstrakt:	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. (Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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