New scoring system predicts chronic pancreatitis outcomes

Last Updated: 2017-10-03

By Will Boggs MD

NEW YORK (Reuters Health) - A new, five-component chronic pancreatitis prognosis score (COPPS) easily assesses disease severity and accurately predicts patient outcomes, researchers report.

"We were generally surprised and pleased to find that a simple scoring system based on five routine parameters - C-reactive protein (CRP), body-mass index (BMI), hemoglobin A1c, platelet count, and worst pain during last week - can predict short- to midterm outcome reliably in chronic pancreatitis," Dr. Georg Beyer from Klinikum der Universitaet Muenchen, in Germany, told Reuters Health by email.

"While some of the parameters - pain, nutritional status (here measured as BMI) - are known to be associated with disease activity in chronic pancreatitis, during the development of COPPS we identified that a low HbA1c and severely abnormal platelet count are also associated with more-severe disease, as reflected by higher likelihood of readmission to hospital," he said.

The predictive strength of the score for hospital admission and length of hospital stay is equal to the reported predictive strength of the Child-Pugh-Turcotte score for mortality in liver cirrhosis, according to his team.

Existing classification systems for chronic pancreatitis do not reliably assess the current severity or likely outcomes of the disease, the authors write.

To develop a simple scoring system, comparable to the Child-Pugh-Turcotte score, the researchers graded each of the five parameters into three categories (1 = within normal range, 2 = moderately altered, 3 = significantly abnormal) for a final composite score ranging from 5 to 15.

Scores were also grouped into three categories - A (5-6 points), B (7-9 points), and C (10-15 points) - indicating increasing risk for readmission.

The composite scores significantly correlated with the total number of hospitalizations, the combined number of days spent in hospital for any reason, and hospitalizations and duration of stays directly linked to pancreatitis, according to the September 15 Gastroenterology online report.

Similarly, the COPPS category correlated with these outcomes, as well as with readmission and number of hospital days.

COPPS results also were significantly associated with the number of therapeutic endoscopies during follow-up, but not with the number of pancreatic surgical procedures, anxiety, quality of life, continued opioid use, continued alcohol consumption, smoking, or the imaging-based Cambridge Classification grade.

"The fact that COPPS, as a clinically driven scoring system, did not correlate well with morphology-based classifications like Cambridge did not come as a surprise, as previous papers and our day-to-day experience in patient care taught us that imaging and disease activity do not always correlate," Dr. Beyer said.

Results were similar in an independent group of 129 patients with confirmed chronic pancreatitis who served as a validation cohort.

"With COPPS we have created an instrument that allows (us) to estimate the risk of readmission to hospital for pancreas-specific and non-specific reasons for the next twelve months," Dr. Beyer said. "It can therefore be used for risk-stratification in outpatients as well as evaluation of treatment success after a change in management."

"Whether the system is capable to identify targets for treatment (e.g., improving glycemic control, pain management, nutritional status, treat inflammation, etc.), and thus perhaps reduce hospital admissions, needs to be tested in a prospective trial," he said. "Most importantly, we hope that non-pancreas specialists will apply COPPS in their daily practice in order to monitor and identify those patients that will benefit from referral to a specialist center."

Dr. Beyer added, "At this point, we are recruiting for a multinational validation study and are happy to include more centers worldwide."

SOURCE: http://bit.ly/2fyccq6

Gastroenterology 2017.