Who's at Risk? A Prognostic Model for Severity Prediction in Pediatric Acute Pancreatitis

Abstract

Objectives: The aim of the study was to validate and optimize a severity prediction model for acute pancreatitis (AP) and to examine blood urea nitrogen (BUN) level changes from admission as a severity predictor. Study Design: Patients from 2 hospitals were included for the validation model (Children’s Hospital of the King’s Daughters and Children’s National Hospital). Children’s Hospital of the King’s Daughters and Cincinnati Children’s Hospital Medical Center data were used for analysis of BUN at 24 to 48 hours. Results: The validation cohort included 73 patients; 22 (30%) with either severe or moderately severe AP, combined into the all severe AP (SAP) group. Patients with SAP had higher BUN ( P = 0.002) and lower albumin ( P = 0.005). Admission BUN was confirmed as a significant predictor ( P = 0.005) of SAP (area under the receiver operating characteristic [AUROC] 0.73, 95% confidence interval [CI] 0.60–0.86). Combining BUN ( P = 0.005) and albumin ( P = 0.004) resulted in better prediction for SAP (AUROC 0.83, 95% CI 0.72–0.94). A total of 176 AP patients were analyzed at 24–48 hours; 39 (22%) met criteria for SAP. Patients who developed SAP had a significantly higher BUN ( P < 0.001) after 24 hours. Elevated BUN levels within 24 to 48 hours were independently predictive of developing SAP (AUROC: 0.76, 95% CI: 0.66–0.85). Patients who developed SAP had a significantly smaller percentage decrease in BUN from admission to 24 to 48 hours ( P = 0.002). Conclusion: We externally validated the prior model with admission BUN levels and further optimized it by incorporating albumin. We also found that persistent elevation of BUN is associated with development of SAP. Our model can be used to risk stratify patients with AP on admission and again at 24 to 48 hours.

The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis

“…Serum albumin together with extrapancreatic fluid collections were suggested as the best indicator of severity of AP at the time of admission [31]. Combining blood urea nitrogen and albumin resulted in better prediction for SAP in pediatric patients [32]. Besides, low albumin is also helpful to predict organ failure in AP [33].…”

Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis

“…The severity of pediatric AP is classified based on organ dysfunction and systemic inflammatory response (10). In children, elevated BUN and lower albumin on admission were found to be predictive of severe AP (29,30). In adults, the association of AP severity and increased opioid utilization has been shown (31).…”

Matrix metalloproteinases and their inhibitors in pediatric severe acute pancreatitis

“…Attempts to identify predictors of SAP in pediatric AP have been ongoing [ 5 , 7 , 22 – 25 ]. Recent studies since the 2017 SAP criteria were published have utilized a uniform definition of pediatric SAP [ 7 , 25 ], however prior studies with utilization of various criteria for SAP have not been able to be well disseminated or widely used. The importance of identifying biomarkers to predict risk for developing SAP cannot be overstated.…”