A clinical risk score for early thrombosis detection in acute and chronic pancreatitis: insights from a large cohort...

Venous thromboembolism (VTE) is a major cause of preventable in-hospital mortality, yet disease-specific risk profiles remain poorly defined. In pancreatitis, one of the most common gastrointestinal causes of hospitalisation, thromboembolic complications are under-recognised, with limited data, especially on extrasplanchnic events. Evidence guiding screening and management remains scarce. We analysed VTE events in a large prospective cohort of patients with acute and chronic pancreatitis and derived a simple admission-time clinical risk score to support early identification of high-risk individuals.

We performed a retrospective analysis of a prospectively recruited cohort at LMU Klinikum Munich, a referral centre for pancreatic diseases. Patients with acute, acute-on-chronic or chronic pancreatitis evaluated between January 2018 and June 2023 were included. Comprehensive clinical, laboratory, imaging and outcome data were extracted. The primary objective was to identify admission-time factors associated with VTE and develop a clinically actionable risk score. Continuous variables were dichotomised using receiver operating characteristic (ROC)-derived optimal cut-points. Binary predictors were entered into a multivariable logistic regression model, and coefficients were scaled to generate an integer-based point score. Discrimination was assessed using the area under the ROC curve (AUC), and patients were stratified into low-risk, intermediate-risk and high-risk groups.

Among 647 patients, 114 (17.6%) developed VTE, with similar incidence rates in acute (59, 16.2%) and chronic pancreatitis (55, 19.5%). Deep vein thrombosis (5.9%) and pulmonary embolism (4.2%) were the most frequent events. Patients with VTE experienced significantly worse clinical courses, including longer hospitalisation (15 vs 7 days, p<0.001), higher rates of severe pancreatitis and increased need for advanced analgesia. Thrombosis was associated with lower diastolic blood pressure, reduced oxygen saturation, tachycardia, older age and lower body mass index at admission as well as higher rates of systemic and local complications. Mortality was markedly higher in patients with VTE (8.8% vs 2.1%, p=0.029). A six-item admission-only risk score (0-8 points) demonstrated good discrimination (AUC 0.71) and effectively stratified patients into low-risk (7.6%), intermediate-risk (22.0%) and high-risk groups (38.5%).

VTE is common in pancreatitis and strongly associated with adverse outcomes. A simple admission-time clinical score reliably identifies high-risk patients and may support earlier recognition, targeted diagnostic evaluation and risk stratification.