The Pancreatitis Activity Scoring System Predicts Clinical Outcomes in Patients With Infected Pancreatic Necrosis.
Adult
Female
Humans
Male
Middle Aged
Multiple Organ Failure
/ complications
Outcome Assessment, Health Care
Pancreas
/ diagnostic imaging
Pancreatitis, Acute Necrotizing
/ complications
Prognosis
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Tomography, X-Ray Computed
/ methods
Journal
Pancreas
ISSN: 1536-4828
Titre abrégé: Pancreas
Pays: United States
ID NLM: 8608542
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
5
8
2021
medline:
8
2
2022
entrez:
4
8
2021
Statut:
ppublish
Résumé
The Pancreatitis Activity Scoring System (PASS) is an objective tool validated in acute pancreatitis but not in infected pancreatic necrosis (IPN). Our aim was to evaluate the role of PASS in IPN. We performed a retrospective cohort study of IPN patients admitted to the University of California, San Francisco from January 2011 to March 2019. Daily PASS scores were calculated for each patient. Receiver operator characteristic analysis was used to define the optimal cutoff PASS score to predict outcomes. The primary and secondary outcomes were 72 hours postintervention multiorgan failure (MOF) and early readmission (within 30 days), respectively. One hundred and four patients underwent intervention (median age, 55 years). Thirty-five patients (33.6%) developed MOF postintervention. A 72-hour postintervention PASS greater than 250 was strongly associated with postintervention MOF (area under curve, 0.87; adjusted odds ratio, 26.83; 95% confidence interval, 6.37-112.86; P < 0.001). Discharge PASS greater than 150 was associated with 30-day readmission (area under curve, 0.82; adjusted odds ratio, 26.44; 95% confidence interval, 8.48-82.43; P < 0.001). The PASS score was associated with postintervention clinical outcomes and early readmission, suggesting it is a valid measure of disease activity in patients with IPN. Further prospective validation of PASS in IPN is needed.
Identifiants
pubmed: 34347734
doi: 10.1097/MPA.0000000000001838
pii: 00006676-202107000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
859-866Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
M.A.A. is a consultant for Boston Scientific, Olympus America, and Medtronic. The remaining authors declare no conflict of interest.
Références
Büchler MW, Gloor B, Müller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg . 2000;232:619–626.
Renner IG, Savage WT 3rd, Pantoja JL, et al. Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci . 1985;30:1005–1018.
Bruno MJ; Dutch Pancreatitis Study Group. Improving the outcome of acute pancreatitis. Dig Dis . 2016;34:540–545.
Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg . 2008;247:294–299.
Connor S, Alexakis N, Raraty MG, et al. Early and late complications after pancreatic necrosectomy. Surgery . 2005;137:499–505.
Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas . 2012;41:1176–1194.
Rau B, Bothe A, Beger HG. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery . 2005;138:28–39.
van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med . 2010;362:1491–1502.
Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis. Gastroenterology . 2019;156:1016–1026.
Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA . 2012;307:1053–1061.
Ross A, Gluck M, Irani S, et al. Combined endoscopic and percutaneous drainage of organized pancreatic necrosis. Gastrointest Endosc . 2010;71:79–84.
van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet . 2018;391:51–58.
Bang JY, Arnoletti JP, Holt BA, et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology . 2019;156:1027–1040.e3.
Kozarek R. Endotherapy for organized pancreatic necrosis. Gastroenterol Hepatol (N Y) . 2013;9:98–127.
Baron TH, Kozarek RA. Endotherapy for organized pancreatic necrosis: perspectives after 20 years. Clin Gastroenterol Hepatol . 2012;10:1202–1207.
Fisher JM, Gardner TB. Endoscopic therapy of necrotizing pancreatitis and pseudocysts. Gastrointest Endosc Clin N Am . 2013;23:787–802.
Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res . 1977;22:79–91.
Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med . 1985;13:818–829.
Brown A, James-Stevenson T, Dyson T, et al. The panc 3 score: a rapid and accurate test for predicting severity on presentation in acute pancreatitis. J Clin Gastroenterol . 2007;41:855–858.
Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology . 2012;142:1476–1482; quiz e15-e16.
Wu BU, Batech M, Quezada M, et al. Dynamic measurement of disease activity in acute pancreatitis: The Pancreatitis Activity Scoring System. Am J Gastroenterol . 2017;112:1144–1152.
Buxbaum J, Quezada M, Chong B, et al. The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study. Am J Gastroenterol . 2018;113:755–764.
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology . 2013;13(4 Suppl 2):e1–e15.
Baron TH, DiMaio CJ, Wang AY, et al. American Gastroenterological Association clinical practice update: management of pancreatic necrosis. Gastroenterology . 2020;158:67–75.e1.
Tenner S, Baillie J, DeWitt J, et al; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol . 2013;108:1400–1415; 1416.
Nemoto Y, Attam R, Arain MA, et al. Interventions for walled off necrosis using an algorithm based endoscopic step-up approach: outcomes in a large cohort of patients. Pancreatology . 2017;17:663–668.
Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med . 2015;372:1629–1638.
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut . 2013;62:102–111.
Eissa D, Carton EG, Buggy DJ. Anaesthetic management of patients with severe sepsis. Br J Anaesth . 2010;105:734–743.
Petrov MS, Shanbhag S, Chakraborty M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology . 2010;139:813–820.
Rizzatti G, Rimbaş M, Larghi A. Endoscopic ultrasound-guided drainage for infected necrotizing pancreatitis: better than surgery but still lacking treatment protocol standardization. Gastroenterology . 2019;157:582–583.
Lee PJ, Bhatt A, Lopez R, et al. Thirty-day readmission predicts 1-year mortality in acute pancreatitis. Pancreas . 2016;45:561–564.
Maatman TK, Mahajan S, Roch AM, et al. High rates of readmission in necrotizing pancreatitis: natural history or opportunity for improvement? J Gastrointest Surg . 2019;23:1834–1839.
Leppin AL, Gionfriddo MR, Kessler M, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med . 2014;174:1095–1107.
Yadav D, Dhir R. How accurate are ICD-9 codes for acute (AP) and chronic (CP) pancreatitis?-A large VA hospital experience. In: Abstracts of Papers Submitted to the 37th Annual Meeting of the American Pancreatic Association and 13th Meeting of the International Association of Pancreatology; November 1–4, 2006, Chicago, Illinois . Pancreas . 2006;33:508.abstract.