The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study.
The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study.
复制标题
DOI：
10.1038/s41395-018-0048-1
复制
发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Wu B
中科院分区：
文献类型：
--
作者：
Buxbaum J;Quezada M;Chong B;Gupta N;Yu CY;Lane C;Da B;Leung K;Shulman I;Pandol S;Wu B
胰腺炎活动评分系统 (PASS) 由国际专家组通过修改后的德尔菲流程得出。我们的目的是进行外部验证研究，以评估 PASS 评分与高表面效度临床结果的一致性，并确定特定的有意义的阈值，以协助在大型前瞻性确定队列中应用该评分系统。我们分析了一项前瞻性队列研究的数据，该研究对 2015 年 3 月至 2017 年 3 月期间洛杉矶县医院收治的连续患者进行了分析。使用急诊科寻呼系统和电子警报系统来识别患者。综合特征包括物质使用史、胰腺炎病因、生化特征和详细的临床病程。我们计算了入院、出院时以及住院期间以 12 小时为增量的 PASS 评分。我们进行了多项分析来评估 PASS 评分与住院期间以及出院后不同时间点的结果之间的关系。使用多变量逻辑回归分析，我们评估了入院 PASS 评分与重症胰腺炎风险之间的关系。将 PASS 评分表现与用于预测重症胰腺炎的现有系统进行比较。评估的其他住院结局包括局部并发症、住院时间、全身炎症反应综合征 (SIRS) 的发生以及重症监护病房 (ICU) 入住。我们还评估了出院时的 PASS 评分是否与早期再入院（出院 30 天内因胰腺炎症状和并发症再次住院）相关。共有 439 名患者入组，平均年龄为 42 (±15) 岁，其中 53% 为男性。入院 PASS 评分 >140 与中度和重度胰腺炎 (OR 3.5 [95% CI 2.0, 6.3])、入住 ICU (OR 4.9 [2.5, 9.4])、局部并发症 (3.0 [1.6, 5.7]) 和 SIRS 的发生 (OR 2.9 [1.8, 4.5]) 以及住院时间延长相关1.5 (1.3–1.7) 天。对于中重度/重度胰腺炎的预测，PASS 评分 (AUC = 0.71) 与更成熟的 Ranson (AUC = 0.63)、格拉斯哥 (AUC = 0.72)、Panc3 (AUC = 0.57) 和 HAPS (AUC = 0.54) 评分系统相当。出院 PASS 评分 >60 与早期再入院相关（OR 5.0 [2.4, 10.7]）。 PASS 评分与急性胰腺炎的重要临床结果相关。该评分能够预测病程中不同点的重要临床事件，表明它是急性胰腺炎患者活动的有效衡量标准。
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. 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). 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]). 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.
登录
查看更多内容
影响因子：
12.6
作者：
Singh, Vikesh K.;Wu, Bechien U.;Banks, Peter A.
通讯作者：
Banks, Peter A.
影响因子：
9.8
作者：
Papachristou, Georgios I.;Muddana, Venkata;Whitcomb, David C.
通讯作者：
Whitcomb, David C.
影响因子：
158.5
作者：
Papp, Kim A.;Blauvelt, Andrew;Padula, Steven J.
通讯作者：
Padula, Steven J.
影响因子：
9.8
作者：
Buxbaum, James L.;Quezada, Michael;Laine, Loren
通讯作者：
Laine, Loren
影响因子：
158.5
作者：
Zuckerman, Rachael B.;Sheingold, Steven H.;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.