A Model to Predict the Severity of Acute Pancreatitis Based on Serum Level of Amylase and Body Mass Index.
Clin Gastroenterol Hepatol. 2015 Mar 25;
Authors: Kumaravel A, Stevens T, Papachristou GI, Muddana V, Bhatt A, Lee PJ, Holmes J, Lopez R, Whitcomb DC, Parsi MA
Abstract
BACKGROUND: & Aims: Most patients with acute pancreatitis (AP) develop mild disease but up to 20% develop severe disease. Many clinicians monitor serum levels of amylase and lipase in an attempt to predict the disease course, but this strategy has not been recommended by practice guidelines. We performed a retrospective analysis to determine whether the percent changes in amylase and lipase were associated with the severity of disease that developed in patients with AP.
METHODS: We analyzed data collected from 182 consecutive patients with AP (21 with severe AP) admitted at the Cleveland Clinic from January 2008 through May 2010 (discover cohort). The association between 11 different factors and severity of AP were assessed by univariable analysis; multivariable models were explored through stepwise selection regression. The percent change in serum level of amylase was calculated as follows: [(amylase day1 - amylase day2)/amylase day1 * 100]. The percent change in amylase and body mass index (BMI) were combined to generate a z-score [z = -5.9 + (0.14*BMI) + (0.01* percent change in amylase)], which was converted into a probability distribution called the change in amylase and BMI (CAB) score. The CAB score was validated using the AP database at the University of Pittsburgh Medical Center (140 patients, 35 with severe AP); we calculated p-scores for each patient and estimated the area under the receiver operating characteristics (AUROC) curve values.
RESULTS: Univariable analysis identified percent change in serum level of amylase and other factors to be significantly associated with severity of AP (P=.017). The CAB score was best at identifying patients who developed severe AP, with an AUROC values of 0.79 in the discovery cohort (95% confidence interval, 0.71-0.87) and 0.731 (95% confidence interval, 0.61-0.84) in the validation cohort CONCLUSION: We developed a model to identify patients most likely to develop severe AP based on percent changes in serum level of amylase during the first 2 days after admission to the hospital and BMI.
PMID: 25818080 [PubMed - as supplied by publisher]