New scoring system tracks disease activity in acute pancreatitis

Last Updated: 2017-05-17

By Will Boggs MD

NEW YORK (Reuters Health) - A new scoring system uses five parameters to allow real-time assessment of clinical disease activity in patients with acute pancreatitis, according to a report from the Southern California Pancreas Study Group.

"The score was developed through a consensus-based process,” Dr. Bechien U. Wu from Kaiser Permanente Los Angeles Medical Center told Reuters Health by email. “It incorporates factors that providers already use in routine clinical assessment. That said, having an objective scale will enable us to compare the impact of treatments on the natural history of disease as well as identify potential areas for quality improvement in the care of patients with acute pancreatitis.”

There are already methods for classifying the severity of acute pancreatitis, but there is no standardized quantitative system to measure disease activity at any given point during its course.

Dr. Wu and colleagues developed and initially validated an acute Pancreatitis Activity Scoring System (PASS) that incorporates clinical parameters and patient-reported symptoms for the assessment of disease activity in patients with acute pancreatitis.

After considering 35 items comprising six domains, the expert panel settled on five parameters as highly relevant in the assessment of acute pancreatitis: organ failure, systemic inflammatory response syndrome (SIRS), abdominal pain, analgesic requirement, and tolerance of oral intake, according to the May 2nd online report in The American Journal of Gastroenterology.

By applying the weighted scoring system across five study cohorts including 3123 patients, the researchers identified three main patterns of disease activity:

- patients with self-limited disease presented with lower scores and experienced a more rapid decline in score;

- patients with prolonged illness presented with higher scores at baseline and exhibited persistent elevation in scores during the initial stage of hospitalization;

- patients who went on to experience multiple or persistent organ failure had increased baseline PASS scores that remained elevated during the initial phase of hospitalization.

“We now have an objective means to assess disease activity in acute pancreatitis,” Dr. Wu concluded. “The focus of our next phase of study (is) to demonstrate how scores can be used to help inform management decisions, such as timing of safe hospital discharge.”

SOURCE: http://go.nature.com/2qsPLsF

Am J Gastroenterol 2017.