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Dynamic changes in the pancreatitis activity scoring system during hospital course in a multicenter, prospective cohort
Author(s) -
Paragomi Pedram,
Tuft Marie,
Pothoulakis Ioannis,
Singh Vikesh K,
Stevens Tyler,
Nawaz Haq,
Easler Jeffrey J,
Thakkar Shyam,
Cote Gregory A,
Lee Peter J,
Akshintala Venkata,
Kamal Ayesha,
Gougol Amir,
Phillips Anna Evans,
Machicado Jorge D,
Whitcomb David C,
Greer Phil J,
Buxbaum James L,
Hart Phil,
Conwell Darwin,
Tang Gong,
Wu Bechien U,
Papachristou Georgios I
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15430
Subject(s) - medicine , cohort , prospective cohort study , acute pancreatitis , pancreatitis , severity of illness , gastroenterology
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).