Risk Models for Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP)
| Autor: | Darren D. Ballard, Sameer D. Saini, Erik Jan Wamsteker, Joshua P. Spaete, Matthew J. DiMagno |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate analysis Endocrinology Diabetes and Metabolism education Chronic liver disease Risk Assessment Gastroenterology Article Endocrinology Predictive Value of Tests Risk Factors Internal medicine Internal Medicine medicine Humans Cholangiopancreatography Endoscopic Retrograde Univariate analysis Endoscopic retrograde cholangiopancreatography Hepatology medicine.diagnostic_test business.industry Liver Diseases Smoking Case-control study Reproducibility of Results Middle Aged Models Theoretical Prognosis medicine.disease Surgery Pancreatitis Case-Control Studies Predictive value of tests Sphincter of Oddi dysfunction Chronic Disease Multivariate Analysis cardiovascular system Female business circulatory and respiratory physiology |
| Zdroj: | Pancreas. 42:996-1003 |
| ISSN: | 0885-3177 |
| Popis: | Objectives We investigated which variables independently associated with protection against or development of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and severity of PEP. Subsequently, we derived predictive risk models for PEP. Methods In a case-control design, 6505 patients had 8264 ERCPs, 211 patients had PEP, and 22 patients had severe PEP. We randomly selected 348 non-PEP controls. We examined 7 established- and 9 investigational variables. Results In univariate analysis, 7 variables predicted PEP: younger age, female sex, suspected sphincter of Oddi dysfunction (SOD), pancreatic sphincterotomy, moderate-difficult cannulation (MDC), pancreatic stent placement, and lower Charlson score. Protective variables were current smoking, former drinking, diabetes, and chronic liver disease (CLD, biliary/transplant complications). Multivariate analysis identified seven independent variables for PEP, three protective (current smoking, CLD-biliary, CLD-transplant/hepatectomy complications) and 4 predictive (younger age, suspected SOD, pancreatic sphincterotomy, MDC). Pre- and post-ERCP risk models of 7 variables have a C-statistic of 0.74. Removing age (seventh variable) did not significantly affect the predictive value (C-statistic of 0.73) and reduced model complexity. Severity of PEP did not associate with any variables by multivariate analysis. Conclusions By using the newly identified protective variables with 3 predictive variables, we derived 2 risk models with a higher predictive value for PEP compared to prior studies. |
| Databáze: | OpenAIRE |
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