The Pancreatitis Activity Scoring System predicts clinical outcomes in acute pancreatitis: findings from a prospective cohort study

Abstract

OBJECTIVES: 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. METHODS: 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). RESULTS: 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]). CONCLUSIONS: 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.

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

“…The Glasgow score is a good prognostic tool for mortality, regardless of the etiology [30]. Buxbaum et al [40] showed an AUC for the Glasgow score to predict an AP severity of 0.73. In turn, Kiat et al [41] verified an AUC for a severity of 0.784.…”

Review of Current Evidence in Acute Pancreatitis

“…SIRS predicts the AP severity at the time of admission and at 48 h post entry. In predicting mortality, it exhibits a sensitivity of 77%-89% and a specificity of 79%-86% [51]. Persistent SIRS in association with multiple organ failure results in 25% mortality, compared to transient SIRS which results in 8% mortality [52].…”

“…It evaluates six variables: age, mean arterial pressure, arterial pH, urea, calcium, and PaO 2 /FiO 2 . The scores range from 0 to 40, a higher score representing higher mortality [51,61,63].…”

Review of Current Evidence in the etiopathogenesis, epidemiology, diagnosis and management of acute pancreatitis

“…It predicts AP severity at admission and at 48 hours. For mortality, it has a sensitivity of 77 to 89% and specificity of 79 to 86% [53]. Persistent SIRS associated with multiple organ failure has 25% mortality compared to transient SIRS, which is 8% [54].…”

“…Evaluate 6 variables: age, mean arterial pressure, arterial pH, urea, calcium, PaO2/FIO 2. The score goes from 0-40; a higher score equals higher mortality [53,63,65].…”