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.

中文翻译：

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改良的胰腺炎活动评分系统显示急性胰腺炎的不同轨迹：一项国际研究

背景与目标

本研究的目的是：（1）评估胰腺炎活动评分系统（PASS）在大型洲际急性胰腺炎（AP）患者队列中的表现；(2) 调查修改后的 PASS (mPASS) 是否产生类似的预测准确性并在严重性亚组之间产生不同的早期轨迹。

方法

数据是通过急性胰腺炎患者登记处前瞻性收集的，以检查临床经验中的新疗法 (APPRENTICE) 联盟 (2015-2018)，涉及来自 4 个大洲的 22 个中心。AP 严重程度根据修订后的亚特兰大分类进行分类。PASS 轨迹使用广义估计方程模型在三个严重组之间进行比较。通过修改吗啡当量剂量 (MED) 生成了四个 mPASS 模型，并比较了它们的轨迹。

结果

共招募了 1393 名受试者（中位年龄，49 岁；51% 为男性）。研究队列包括 950 名轻度 (68.2%)、315 名 (22.6%) 中重度和 128 名 (9.2%) 重度 AP。轻度病例在每个研究时间点的通过率最低（所有P < .001）。确定了具有异常入院 PASS 值的患者子集。在异常组中，70% 的 PASS 变异归因于 MED，其中 66% 的患者来自美国中心。在 4 个修改模型中，mPASS-1（不包括 PASS 中的 MED）在预测严重 AP 方面表现出高性能，其受试者工作特征曲线下面积为 0.88（相对于传统 PASS 的受试者工作特征曲线下面积为 0.83），并产生了严重性亚组之间具有不同斜率的不同轨迹（所有P < .001)。

结论

我们通过删除 MED 组件提出了一个修改模型，该组件更易于计算，准确预测严重 AP，并保持明显不同的早期轨迹。