Article | Published:

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

The American Journal of Gastroenterologyvolume 113pages755764 (2018) | Download Citation

Subjects

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.

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Author information

Affiliations

  1. Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA

    • James Buxbaum MD
    • , Michael Quezada MD
    • , Bradford Chong MD
    • , Nikhil Gupta MD
    • , Chung Yao Yu MD
    • , Ben Da MD
    •  & Kenneth Leung MD
  2. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA

    • Christianne Lane PhD
  3. Department of Laboratory Medicine, University of Southern California, Los Angeles, CA, USA

    • Ira Shulman MD
  4. Cedars-Sinai Medical Center VA Greater Los Angeles Healthcare System and University of California, Los Angeles, CA, USA

    • Stephen Pandol MD
  5. Center for Pancreatic Care, Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    • Bechien Wu MD

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Guarantor of the article

James Buxbaum.

Specific author contributions

Concept and design: JB, MQ, BC, SP, BW. Acquisition of data: JB, MQ, BC, NG, CY, BD, KL, IS. Statistical analysis and interpretation of data: JB, CL, SP, BW. Drafting and revision of manuscript: All the authors.

Financial support

This publication was supported by NIH/NCRR SC CTSI Grant Number UL1TR000130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Potential competing interests

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to James Buxbaum MD.

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DOI

https://doi.org/10.1038/s41395-018-0048-1