Gastroenterology

Gastroenterology

Volume 153, Issue 6, December 2017, Pages 1544-1554.e2
Gastroenterology

Original Research
Full Report: Clinical—Pancreas
Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent Cohorts

https://doi.org/10.1053/j.gastro.2017.08.073Get rights and content

Background & Aims

The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes.

Methods

We performed a prospective study of 91 patients with chronic pancreatitis; data were collected from patients seen at academic centers in Europe from January 2011 through April 2014. We analyzed correlations between clinical, laboratory, and imaging data with number of hospital readmissions and in-hospital days over the next 12 months; the parameters with the highest degree of correlation were used to develop a 3-stage chronic pancreatitis prognosis score (COPPS). The predictive strength was validated in 129 independent subjects identified from 2 prospective databases.

Results

The mean number of hospital admissions was 1.9 (95% confidence interval [CI], 1.39–2.44) and 15.2 for hospital days (95% CI, 10.76–19.71) for the development cohort and 10.9 for the validation cohort (95% CI, 7.54–14.30) (P = .08). Based on bivariate correlations, pain (numeric rating scale), level of glycated hemoglobin A1c, level of C-reactive protein, body mass index, and platelet count were used to develop the COPPS system. The patients’ median COPPS was 8.9 points (range, 5–14). The system accurately discriminated stages of disease severity (low to high): A (5–6 points), B (7–9), and C (10–15). In Pearson correlation analysis of the development cohort, the COPPS correlated with hospital admissions (0.39; P < .01) and number of hospital days (0.33; P < .01). The correlation was validated in the validation set (Pearson correlation values of 0.36 and 0.44; P < .01). COPPS did not correlate with results from the Cambridge classification system.

Conclusions

We developed and validated an easy to use dynamic multivariate scoring system, similar to the Child-Pugh-Score for liver cirrhosis. The COPPS allows objective monitoring of patients with chronic pancreatitis, determining risk for readmission to hospital and potential length of hospital stay.

Section snippets

Aims and Study Design

This study was designed according to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement (TRIPOD).16 In the first phase, we conducted a prospective single-center cohort study on 91 patients (development cohort) with preexisting chronic pancreatitis to develop a severity scoring system in chronic pancreatitis, by using readily available routine laboratory parameters, BMI, imaging, and standardized assessment of pain symptoms. In the

Baseline Parameters Development Cohort

Between January 2011 and January 2013, 91 patients with unequivocal evidence of chronic pancreatitis were prospectively included. Four of these cases were recruited from the outpatient clinic, all others were hospitalized at the time of inclusion. The median age was 55 (range, 25–88 years), 20 cases (22.0%) were women and 71 cases (78%) were men. Suspected etiology of pancreatitis was alcoholic (67.0%), obstructive (2.2%), hereditary (3.3%), and autoimmune (1.1%); the remaining cases were

Discussion

The worldwide incidence of chronic pancreatitis is reported to be between 1.6 and 23 per 100, 000, with an increasing prevalence.21 Although most patients with chronic pancreatitis are treated as outpatients, in 2008 there were 10. 267 (International Classification of Diseases, 10th Revision: K86) hospital admissions for chronic pancreatitis in Germany alone (Federal Statistics Office). This does not include those patients who were coded as having acute pancreatitis, including those due to an

Conclusion

In a type 3 study regarding the TRIPOD reporting criteria, we developed a multivariate prediction model to foresee the individual short-term (12-month) prognosis of patients suffering from chronic pancreatitis by using C-reactive protein, platelet count, HbA1c, BMI, and pain.

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    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by the Deutsche Krebshilfe/Dr. Mildred-Scheel-Stiftung (109102), the Deutsche Forschungsgemeinschaft (DFG 1947/A3, MA 4115/1-2/3), the European Union (EU-FP-7: EPC-TM), BMBF FKZ: 01EK1511A, and Landesexzellenzinitiative MV – PePPP.

    Author names in bold designate shared co-first authorship

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