Background and Aims

We sought to derive a risk score, DORM65, of known variables to predict the likelihood of a positive EUS in patients with idiopathic acute pancreatitis (IAP).

Methods

A retrospective cohort study of 180 patients with IAP was performed across 3 tertiary care centers between January 2018 and December 2021. Multivariate logistic regression modeling was performed to predict a positive EUS. Accuracy of the models was assessed by the area under the receiver-operating characteristic curve (AUROCC).

Results

The diagnostic yield of EUS was 58.9% (95% confidence interval [CI], 51.7-66.1). The DORM65 scores of 5 predictors present before EUS with the best discrimination were a delayed EUS (defined as ≥82 days from the last episode of AP), obesity, not having had a repeated transabdominal US, male sex, and age ≥65 years at the time of EUS. For those at the lowest risk score group, the positive EUS rate was 13.0% compared with 100% in those at the highest risk group (relative risk, 7.67; P < .001). A score of 3 or more had a positive predictive value of 86.0% with a sensitivity of 34.9% and specificity of 91.9%. The model had a high predictive accuracy (AUROCC, .774; 95% CI, .707-.841). Adding 3 additional predictors (no cholecystectomy, no MRCP, and a single episode of AP) did not increase the accuracy significantly (AUROCC, .805; 95% CI, .742-.867).

Conclusions

DORM65 is easily calculated and accurately predicts a positive EUS in patients with IAP. Further validation is needed.

中文翻译：

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预测特发性急性胰腺炎 EUS 阳性可能性的简单风险评分

背景和目标

我们试图推导出已知变量的风险评分 DORM65，以预测特发性急性胰腺炎 (IAP) 患者 EUS 阳性的可能性。

方法

2018 年 1 月至 2021 年 12 月，在 3 个三级医疗中心对 180 名 IAP 患者进行了回顾性队列研究。采用多变量逻辑回归模型预测 EUS 阳性。模型的准确性通过接受者操作特征曲线 (AUROCC) 下的面积进行评估。

结果

EUS 的诊断率为 58.9%（95% 置信区间 [CI]，51.7-66.1）。EUS 前存在的 5 个预测因素的 DORM65 评分具有最佳辨别力，它们是延迟 EUS（定义为距离最后一次 AP 发作≥82 天）、肥胖、没有重复经腹超声、男性和年龄≥65 岁EUS 的时间。对于风险评分最低的组，EUS 阳性率为 13.0%，而风险最高组的阳性率为 100%（相对风险，7.67；P <.001）。3 分或以上的阳性预测值为 86.0%，敏感性为 34.9%，特异性为 91.9%。该模型具有很高的预测准确性（AUROCC，0.774；95% CI，0.707-0.841）。添加 3 个额外的预测因子（无胆囊切除术、无 MRCP 和单次 AP 发作）并未显着提高准确性（AUROCC，0.805；95% CI，0.742-0.867）。

结论

DORM65 易于计算并准确预测 IAP 患者的 EUS 阳性。需要进一步验证。