Pedram Paragomi1, Alice Hinton2, Ioannis Pothoulakis3, Rupjyoti Talukdar4, Rakesh Kochhar5, Mahesh K Goenka6, Aiste Gulla7, Jose A Gonzalez8, Vikesh K Singh9, Miguel Ferreira Bogado10, Tyler Stevens11, Sorin T Barbu12, Haq Nawaz13, Silvia C Gutierrez14, Narcis Zarnescu15, Livia Archibugi16, Jeffrey J Easler17, Konstantinos Triantafyllou18, Mario Peláez-Luna19, Shyam Thakkar20, Carlos Ocampo21, Gregory A Cote22, Peter J Lee23, Somashekar Krishna24, Luis F Lara24, Samuel Han24, Bechien U Wu25, Georgios I Papachristou26. 1. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania. 2. Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio. 3. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; MedStar Washington Hospital Center, Washington, District of Columbia. 4. Asian Gastroenterology Institute, Hyderabad, India. 5. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 6. Apollo Gleneagles Hospitals Kolkata, Kolkata, India. 7. Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Georgetown University Hospital, Washington DC. 8. Universidad Autónoma de Nueva León, Monterrey, Mexico. 9. Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, MA. 10. Hospital Nacional de Itauguá, Itaugua, Paraguay. 11. Cleveland Clinic, Cleveland, Ohio. 12. University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania. 13. Eastern Maine Medical Center, Bangor, Maine. 14. Hospital Nacional "Profesor Alejandro Posadas," Buenos Aires, Argentina. 15. University of Medicine and Pharmacy, Bucharest, Romania. 16. 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. 17. Indiana University School of Medicine, Indianapolis, Indiana. 18. Attikon University General Hospital, Athens, Greece. 19. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico. 20. Division of Gastroenterology, West Virginia University, Morgantown, West Virginia. 21. Hospital General de Argudos "Dr. Cosme Argerich," Buenos Aires, Argentina. 22. Medical University of South Carolina, Charleston, South Carolina. 23. Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 24. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio. 25. Kaiser Permanente, Los Angeles, California. 26. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio. Electronic address: georgios.papachristou@osumc.edu.
Abstract
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.
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.
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Authors: Pedram Paragomi; Marie Tuft; Ioannis Pothoulakis; Vikesh K Singh; Tyler Stevens; Haq Nawaz; Jeffrey J Easler; Shyam Thakkar; Gregory A Cote; Peter J Lee; Venkata Akshintala; Ayesha Kamal; Amir Gougol; Anna Evans Phillips; Jorge D Machicado; David C Whitcomb; Phil J Greer; James L Buxbaum; Phil Hart; Darwin Conwell; Gong Tang; Bechien U Wu; Georgios I Papachristou Journal: J Gastroenterol Hepatol Date: 2021-02-18 Impact factor: 4.369
Authors: Georgios I Papachristou; Jorge D Machicado; Tyler Stevens; Mahesh Kumar Goenka; Miguel Ferreira; Silvia C Gutierrez; Vikesh K Singh; Ayesha Kamal; Jose A Gonzalez-Gonzalez; Mario Pelaez-Luna; Aiste Gulla; Narcis O Zarnescu; Konstantinos Triantafyllou; Sorin T Barbu; Jeffrey Easler; Carlos Ocampo; Gabriele Capurso; Livia Archibugi; Gregory A Cote; Louis Lambiase; Rakesh Kochhar; Tiffany Chua; Subhash Ch Tiwari; Haq Nawaz; Walter G Park; Enrique de-Madaria; Peter J Lee; Bechien U Wu; Phil J Greer; Mohannad Dugum; Efstratios Koutroumpakis; Venkata Akshintala; Amir Gougol Journal: Ann Gastroenterol Date: 2016-12-01