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




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.


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).


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]).


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.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Vege SS, Atwal T, Bi Y, et al. Pentoxifylline treatment in severe acute pancreatitis: a pilot, double-blind, placebo-controlled, randomized trial. Gastroenterology. 2015;149:318–20 e3.

  2. 2.

    Isenmann R, Runzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology. 2004;126:997–1004.

  3. 3.

    Johnson CD, Kingsnorth AN, Imrie CW, et al. Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut. 2001;48:62–9.

  4. 4.

    Bakker OJ, van Brunschot S, van Santvoort HC, et al. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med. 2014;371:1983–93.

  5. 5.

    Buxbaum JL, Quezada M, Da B, et al. Early aggressive hydration hastens clinical improvement in mild acute pancreatitis. Am J Gastroenterol. 2017;112:797–803.

  6. 6.

    Papp KA, Blauvelt A, Bukhalo M, et al. Risankizumab versus ustekinumab for moderate-to-severe plaque psoriasis. N Engl J Med. 2017;376:1551–60.

  7. 7.

    Monteleone G, Neurath MF, Ardizzone S, et al. Mongersen, an oral SMAD7 antisense oligonucleotide, and Crohn’s disease. N Engl J Med. 2015;372:1104–13.

  8. 8.

    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;112:1144–52.

  9. 9.

    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;142:1476–82. quize15-6

  10. 10.

    Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105:435–41. quiz 442

  11. 11.

    Lee PJ, Bhatt A, Lopez R, et al. Thirty-day readmission predicts 1-year mortality in acute pancreatitis. Pancreas. 2016;45:561–4.

  12. 12.

    Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–28.

  13. 13.

    Singh VK, Wu BU, Bollen TL, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7:1247–51.

  14. 14.

    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;62:102–11.

  15. 15.

    Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.

  16. 16.

    da Costa DW, Bouwense SA, Schepers NJ, et al. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet. 2015;386:1261–8.

  17. 17.

    Lankisch PG, Weber-Dany B, Hebel K, et al. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol. 2009;7:702–5. quiz 607

  18. 18.

    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;41:855–8.

  19. 19.

    Afghani E, Pandol SJ, Shimosegawa T, et al. Acute pancreatitis-progress and challenges: a report on an International Symposium. Pancreas. 2015;44:1195–210.

  20. 20.

    Lum HD, Studenski SA, Degenholtz HB, et al. Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. J Gen Intern Med. 2012;27:1467–74.

  21. 21.

    Krumholz HM, Lin Z, Keenan PS, et al. Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA. 2013;309:587–93.

  22. 22.

    Zuckerman RB, Sheingold SH, Orav EJ, et al. Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016;374:1543–51.

  23. 23.

    Vipperla K, Papachristou GI, Easler J, et al. Risk of and factors associated with readmission after a sentinel attack of acute pancreatitis. Clin Gastroenterol Hepatol. 2014;12:1911–9.

  24. 24.

    Whitlock TL, Repas K, Tignor A, et al. Early readmission in acute pancreatitis: incidence and risk factors. Am J Gastroenterol. 2010;105:2492–7.

  25. 25.

    Yadav D, O’Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol. 2012;107:1096–103.

  26. 26.

    Whitlock TL, Tignor A, Webster EM, et al. A scoring system to predict readmission of patients with acute pancreatitis to the hospital within thirty days of discharge. Clin Gastroenterol Hepatol. 2011;9:175–80. quize18

  27. 27.

    Wu BU, Bakker OJ, Papachristou GI, et al. Blood urea nitrogen in the early assessment of acute pancreatitis: an international validation study. Arch Intern Med. 2011;171:669–76.

  28. 28.

    Muddana V, Whitcomb DC, Khalid A, et al. Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. Am J Gastroenterol. 2009;104:164–70.

  29. 29.

    Brown LA, Sofer T, Stilp AM, et al. Admixture mapping identifies an Amerindian ancestry locus associated with albuminuria in Hispanics in the United States. J Am Soc Nephrol. 2017;28:2211–20.

Download references

Author information


  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


  1. Search for James Buxbaum MD in:

  2. Search for Michael Quezada MD in:

  3. Search for Bradford Chong MD in:

  4. Search for Nikhil Gupta MD in:

  5. Search for Chung Yao Yu MD in:

  6. Search for Christianne Lane PhD in:

  7. Search for Ben Da MD in:

  8. Search for Kenneth Leung MD in:

  9. Search for Ira Shulman MD in:

  10. Search for Stephen Pandol MD in:

  11. Search for Bechien Wu MD in:

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.

Electronic supplementary material

About this article

Publication history