Acute Pancreatitis—Progress and Challenges

Afghani, Elham; Pandol, Stephen J.; Shimosegawa, Tooru; Sutton, Robert M.; Wu, Bechien U.; Vege, Santhi Swaroop; Gorelick, Fred S.; Hirota, Morihisa; Windsor, John A.; Lo, Simon K.; Freeman, Martin L.; Lerch, Markus M.; Tsuji, Yoshihisa; Melmed, Gil Y.; Wassef, Wahid; Mayerle, Julia

doi:10.1097/mpa.0000000000000500

Cited by 89 publications

(41 citation statements)

References 149 publications

(155 reference statements)

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“…Results of the systematic review and a list of candidate parameters for inclusion in the score have been previously reported (8). From an initial review of 345 abstracts, we identified 69 studies that met full inclusion and exclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…To identify items for potential inclusion in the activity score we performed a systematic literature review of clinical outcome and assessment measures used in previous randomized controlled trials in acute pancreatitis (8). Specifically, we conducted a search of PubMed, Embase and the Cochrane database of studies published from 1996 to 2014 that met the following criteria: randomized control trials, English language, use of Human subjects, and studies that evaluated the effect of therapy in acute pancreatitis.…”

Section: Methodsmentioning

confidence: 99%

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Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System

Batech

Quezada

et al. 2017

American Journal of Gastroenterology

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OBJECTIVES Acute pancreatitis has a highly variable course. Currently there is no widely accepted method to measure disease activity in patients hospitalized for acute pancreatitis. We aimed to develop a clinical activity index that incorporates routine clinical parameters to assist in the measurement, study, and management of acute pancreatitis. METHODS We used the UCLA/RAND appropriateness method to identify items for inclusion in the disease activity instrument. We conducted a systematic literature review followed by two sets of iterative modified Delphi meetings including a panel of international experts between November 2014 and November 2015. The final instrument was then applied to patient data obtained from five separate study cohorts across Southern California to assess profiles of disease activity. RESULTS From a list of 35 items comprising 6 domains, we identified 5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake. We applied the weighted scoring system across the 5 study cohorts comprising 3,123 patients. We identified several distinct patterns of disease activity: (i) overall there was an elevated score at baseline relative to discharge across all study cohorts, (ii) there were distinct patterns of disease activity related to duration of illness as well as (iii) early and persistent elevation of disease activity among patients with severe acute pancreatitis defined as persistent organ failure. CONCLUSIONS We present the development and initial validation of a clinical activity score for real-time assessment of disease activity in patients with acute pancreatitis.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System

Batech

Quezada

et al. 2017

American Journal of Gastroenterology

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“…The development of pharmacologic and other therapy for acute pancreatitis requires the demonstration of quantifiable improvement in clinical outcomes [19]. Given its correlation with multiple aspects of the clinical course of pancreatitis, PASS represents a promising tool to gauge responses to therapy as well as to assess for the resolution of disease.…”

Section: Discussionmentioning

confidence: 99%

The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

Buxbaum

Quezada

Chong

et al. 2018

American Journal of Gastroenterology

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OBJECTIVES: The Pancreatitis Activity Scoring System (PASS) has been derived by an international group of experts via a modified Delphi process. Our aim was to perform an external validation study to assess for concordance of the PASS score with high face validity clinical outcomes and determine specific meaningful thresholds to assist in application of this scoring system in a large prospectively ascertained cohort. METHODS: We analyzed data from a prospective cohort study of consecutive patients admitted to the Los Angeles County Hospital between March 2015 and March 2017. Patients were identified using an emergency department paging system and electronic alert system. Comprehensive characterization included substance use history, pancreatitis etiology, biochemical profile, and detailed clinical course. We calculated the PASS score at admission, discharge, and at 12 h increments during the hospitalization. We performed several analyses to assess the relationship between the PASS score and outcomes at various points during hospitalization as well as following discharge. Using multivariable logistic regression analysis, we assessed the relationship between admission PASS score and risk of severe pancreatitis. PASS score performance was compared to established systems used to predict severe pancreatitis. Additional inpatient outcomes assessed included local complications, length of stay, development of systemic inflammatory response syndrome (SIRS), and intensive care unit (ICU) admission. We also assessed whether the PASS score at discharge was associated with early readmission (re-hospitalization for pancreatitis symptoms and complications within 30 days of discharge). RESULTS: A total of 439 patients were enrolled, their mean age was 42 (±15) years, and 53% were male. Admission PASS score >140 was associated with moderately severe and severe pancreatitis (OR 3.5 [95% CI 2.0, 6.3]), ICU admission (OR 4.9 [2.5, 9.4]), local complications (3.0 [1.6, 5.7]), and development of SIRS (OR 2.9 [1.8, 4.5]) as well as prolongation of hospitalization by a mean of 1.5 (1.3–1.7) days. For the prediction of moderately severe/severe pancreatitis, the PASS score (AUC = 0.71) was comparable to the more established Ranson’s (AUC = 0.63), Glasgow (AUC = 0.72), Panc3 (AUC = 0.57), and HAPS (AUC = 0.54) scoring systems. Discharge PASS score >60 was associated with early readmission (OR 5.0 [2.4, 10.7]). CONCLUSIONS: The PASS score is associated with important clinical outcomes in acute pancreatitis. The ability of the score to forecast important clinical events at different points in the disease course suggests that it is a valid measure of activity in patients with acute pancreatitis.

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“…[ 43 ] Early severity assessment is important, especially in the first 48 hours of admission with respect to the window of opportunity for using interventions to prevent necrosis. [ 44 ] However, some parameters, such as the CRP, need more than 48 hours to reach a peak value, which may influence the diagnostic accuracy. Even with its delayed increase and peak, CRP remains useful and widely available.…”

Section: Discussionmentioning

confidence: 99%

Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis

Chen

et al. 2017

Medicine

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Acute Pancreatitis—Progress and Challenges

Cited by 89 publications

References 149 publications

Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System

Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System

The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis

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