The Modified Pancreatitis Activity Scoring System Shows Distinct Trajectories in Acute Pancreatitis: An International...

Area of Science:

• Gastroenterology and Hepatology
• Clinical Medicine
• Medical Diagnostics

Background:

• Acute pancreatitis (AP) management requires accurate severity assessment.
• The Pancreatitis Activity Scoring System (PASS) is used for AP severity evaluation.
• Limitations in PASS, particularly concerning morphine equivalent dose (MED), necessitate performance assessment and potential modification.

Purpose of the Study:

• To evaluate the performance of the PASS in a large, diverse patient cohort.
• To investigate the predictive accuracy and trajectory differentiation of a modified PASS (mPASS).
• To determine if mPASS offers advantages over conventional PASS in assessing AP severity.

Main Methods:

• Prospective data collection from the APPRENTICE consortium (22 centers, 4 continents, 2015-2018).
• Categorization of AP severity using the revised Atlanta classification.
• Development and comparison of four mPASS models, excluding or modifying the MED component, against conventional PASS using generalized estimating equations.

Main Results:

• A cohort of 1393 patients with AP was analyzed (950 mild, 315 moderately severe, 128 severe).
• The modified PASS (mPASS-1), excluding MED, showed superior prediction of severe AP (AUC 0.88 vs. 0.83 for PASS).
• mPASS-1 demonstrated distinct early disease trajectories between severity subgroups, with significantly different slopes (P < .001).

Conclusions:

• A modified PASS model excluding MED (mPASS-1) is proposed.
• This mPASS is simpler to calculate and accurately predicts severe AP.
• The mPASS maintains distinct early trajectories, aiding in AP severity subgroup differentiation.