Pedram Paragomi1, Marie Tuft2, Ioannis Pothoulakis3,4, Vikesh K Singh5, Tyler Stevens6, Haq Nawaz7, Jeffrey J Easler8, Shyam Thakkar9, Gregory A Cote10, Peter J Lee11, Venkata Akshintala5, Ayesha Kamal5, Amir Gougol12, Anna Evans Phillips12, Jorge D Machicado13, David C Whitcomb12, Phil J Greer12, James L Buxbaum14, Phil Hart15, Darwin Conwell15, Gong Tang2, Bechien U Wu16, Georgios I Papachristou15. 1. Department of Medicine, Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 3. MedStar Washington Hospital Center, Washington, District of Columbia, USA. 4. Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, UPMC, Pittsburgh, Pennsylvania, USA. 5. Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, Maryland, USA. 6. Cleveland Clinic Foundation, Cleveland, Ohio, USA. 7. Eastern Maine Medical Center, Bangor, Maine, USA. 8. Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA. 9. Division of Gastroenterology, West Virginia University, Morgantown, West Virginia, USA. 10. Division of Gastroenterology, Medical University of South Carolina, Charleston, West Virginia, USA. 11. Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 12. Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 13. Division of Gastroenterology, Mayo Clinic Healthcare System, Eau Claire, Wisconsin, USA. 14. Division of Gastroenterology, Department of Internal Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA. 15. Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University, Wexner Medical Center, Columbus, Ohio, USA. 16. Division of Gastroenterology, Kaiser Permanente, Pasadena, California, USA.
Abstract
BACKGROUND AND AIM: The primary aim was to validate the Pancreatitis Activity Scoring System (PASS) in a multicenter prospectively ascertained acute pancreatitis (AP) cohort. Second, we investigated the association of early PASS trajectories with disease severity and length of hospital stay (LOS). METHODS: Data were prospectively collected through the APPRENTICE consortium (2015-2018). AP severity was categorized based on revised Atlanta classification. Delta PASS (ΔPASS) was calculated by subtracting activity score from baseline value. PASS trajectories were compared between severity subsets. Subsequently, the cohort was subdivided into three LOS subgroups as short (S-LOS): 2-3 days; intermediate (I-LOS): 3-7 days; and long (L-LOS): ≥7 days. The generalized estimating equations model was implemented to compare PASS trajectories. RESULTS: There were 434 subjects analyzed including 322 (74%) mild, 86 (20%) moderately severe, and 26 (6%) severe AP. Severe AP subjects had the highest activity levels and the slowest rate of decline in activity (P = 0.039). Focusing on mild AP, L-LOS subjects (34%) had 28 points per day slower decline; whereas, S-LOS group (13%) showed 34 points per day sharper decrease compared with I-LOS (53%; P < 0.001). We noticed an outlier subset with a median admission-PASS of 466 compared with 140 in the rest. Morphine equivalent dose constituted 80% of the total PASS in the outliers (median morphine equivalent dose score = 392), compared with only 25% in normal-range subjects (score = 33, P value < 0.001). CONCLUSIONS: This study highlighted that PASS can quantify AP activity. Significant differences in PASS trajectories were found both in revised Atlanta classification severity and LOS groups, which can be harnessed in AP monitoring/management (ClincialTrials.gov number, NCT03075618).
BACKGROUND AND AIM: The primary aim was to validate the Pancreatitis Activity Scoring System (PASS) in a multicenter prospectively ascertained acute pancreatitis (AP) cohort. Second, we investigated the association of early PASS trajectories with disease severity and length of hospital stay (LOS). METHODS: Data were prospectively collected through the APPRENTICE consortium (2015-2018). AP severity was categorized based on revised Atlanta classification. Delta PASS (ΔPASS) was calculated by subtracting activity score from baseline value. PASS trajectories were compared between severity subsets. Subsequently, the cohort was subdivided into three LOS subgroups as short (S-LOS): 2-3 days; intermediate (I-LOS): 3-7 days; and long (L-LOS): ≥7 days. The generalized estimating equations model was implemented to compare PASS trajectories. RESULTS: There were 434 subjects analyzed including 322 (74%) mild, 86 (20%) moderately severe, and 26 (6%) severe AP. Severe AP subjects had the highest activity levels and the slowest rate of decline in activity (P = 0.039). Focusing on mild AP, L-LOS subjects (34%) had 28 points per day slower decline; whereas, S-LOS group (13%) showed 34 points per day sharper decrease compared with I-LOS (53%; P < 0.001). We noticed an outlier subset with a median admission-PASS of 466 compared with 140 in the rest. Morphine equivalent dose constituted 80% of the total PASS in the outliers (median morphine equivalent dose score = 392), compared with only 25% in normal-range subjects (score = 33, P value < 0.001). CONCLUSIONS: This study highlighted that PASS can quantify AP activity. Significant differences in PASS trajectories were found both in revised Atlanta classification severity and LOS groups, which can be harnessed in AP monitoring/management (ClincialTrials.gov number, NCT03075618).
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Giovanni Monteleone; Markus F Neurath; Sandro Ardizzone; Antonio Di Sabatino; Massimo C Fantini; Fabiana Castiglione; Maria L Scribano; Alessandro Armuzzi; Flavio Caprioli; Giacomo C Sturniolo; Francesca Rogai; Maurizio Vecchi; Raja Atreya; Fabrizio Bossa; Sara Onali; Maria Fichera; Gino R Corazza; Livia Biancone; Vincenzo Savarino; Roberta Pica; Ambrogio Orlando; Francesco Pallone Journal: N Engl J Med Date: 2015-03-19 Impact factor: 91.245
Authors: Peter A Banks; Thomas L Bollen; Christos Dervenis; Hein G Gooszen; Colin D Johnson; Michael G Sarr; Gregory G Tsiotos; Santhi Swaroop Vege Journal: Gut Date: 2012-10-25 Impact factor: 23.059
Authors: Vikesh K Singh; Bechien U Wu; Thomas L Bollen; Kathryn Repas; Rie Maurer; Koenraad J Mortele; Peter A Banks Journal: Clin Gastroenterol Hepatol Date: 2009-08-15 Impact factor: 11.382
Authors: Pedram Paragomi; Alice Hinton; Ioannis Pothoulakis; Rupjyoti Talukdar; Rakesh Kochhar; Mahesh K Goenka; Aiste Gulla; Jose A Gonzalez; Vikesh K Singh; Miguel Ferreira Bogado; Tyler Stevens; Sorin T Barbu; Haq Nawaz; Silvia C Gutierrez; Narcis Zarnescu; Livia Archibugi; Jeffrey J Easler; Konstantinos Triantafyllou; Mario Peláez-Luna; Shyam Thakkar; Carlos Ocampo; Gregory A Cote; Peter J Lee; Somashekar Krishna; Luis F Lara; Samuel Han; Bechien U Wu; Georgios I Papachristou Journal: Clin Gastroenterol Hepatol Date: 2021-09-17 Impact factor: 13.576
Authors: Jorge D Machicado; Rawad Mounzer; Pedram Paragomi; Ioannis Pothoulakis; Phil A Hart; Darwin L Conwell; Enrique de-Madaria; Phil Greer; Dhiraj Yadav; David C Whitcomb; Peter J Lee; Alice Hinton; Georgios I Papachristou Journal: Clin Transl Gastroenterol Date: 2021-10-27 Impact factor: 4.488