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A prognostic tool to predict severe acute pancreatitis in pediatrics |
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| Institution: | 1. Division of Gastroenterology Hepatology and Nutrition; Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;2. Division of Biostatistics and Epidemiology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;3. Division of Gastroenterology Hepatology and Nutrition, Children''s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA;4. Division of Gastroenterology Hepatology and Nutrition, Children''s Hospital Los Angeles, Los Angeles, CA, USA;5. Division of Pediatric General and Thoracic Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;6. Department of Radiology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;7. Department of Radiology, Nemours Children''s Hospital, Orlando, FL, USA;2. Department of Pediatrics, The Children׳s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;3. Department of Anesthesia and Critical Care Medicine, The Children׳s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;1. Department of Orthopaedic Surgery, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA;2. Department of Orthopaedic Surgery, St. Christopher’s Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA 19134, USA;1. Vanderbilt University Medical Center, Nashville, Tennessee, USA;2. MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA;3. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;4. UT Southwestern Medical Center, Dallas, Texas, USA;5. UH Cleveland Medical Center, Cleveland, Ohio, USA;6. University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA;7. Massachusetts General Hospital, Boston, Massachusetts, USA;8. Kannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA;9. Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA;1. School of Women''s and Children''s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;2. Department of Gastroenterology, John Hunter Children''s Hospital, Newcastle, NSW, Australia;3. Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia;4. Department of Gastroenterology, Sydney Children''s Hospital Randwick, Sydney, NSW, Australia |
| Abstract: | Background/ObjectivesApproximately 15–20% of pediatric patients with acute pancreatitis (AP) develop severe disease. Severity scoring tools were developed for adult patients, but have limitations when applied in children. We aimed to identify early predictors of severe acute pancreatitis (SAP) on hospital admission for early risk stratification of patients.MethodsRetrospective review of AP admissions was conducted. The derivation cohort included cases at Cincinnati Children's Hospital Medical Center (CCHMC) between 2009 and 2013. Clinical data collected during the first 24 h of admission were analyzed and a predictive model was derived through statistical analysis. The performance of the model was evaluated in a validation cohort from 2 more institutions other than CCHMC.ResultsIn the derivation cohort 19% of the 284 admissions were SAP. A generalized linear mixed effect model analysis revealed that lipase, albumin and white blood count (WBC) play a role in the development of SAP (area under the receiver operating curve (AUROC 0.76)). In the validation cohort of 165 AP cases, SAP ranged from 8 to 20% at the three institutions. Performance of the model in this cohort was comparable to the derivation model (AUROC 0.77). There were 369 encounters in the combined derivation and validation pool (AUROC 0.76).ConclusionsThe prognostic severity tool with 3 variables (lipase, albumin, and WBC) obtained within 24 h of admission can be applied to predict SAP in pediatric patients. |
| Keywords: | Pediatric pancreatitis Prognostic markers Prognostic model Severe acute pancreatitis Derivation cohort Validation cohort AP"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"acute pancreatitis AUROC"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"Area Under the Receiver Operating Characteristic Curve CHLA"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"Children's Hospital of Los Angeles CHP"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"Children's Hospital of Pittsburgh of UPMC CCHMC"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"Cincinnati Children's Hospital Medical Center EMR"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"electronic medical record ER"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"emergency room ROC"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"receiver operating characteristic SAP"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"severe acute pancreatitis ULN"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"upper limit of normal |
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