University of Texas Health Science Center at Houston Houston, TX, United States
Jason Wagner, MD, Abraham Yu, MD, Victor Garcia-Rodriguez, MD, Wasay Mohajir, DO, Colin Goodman, BSc, Andrew DuPont, MD, Ahmad Farooq, MD, Yllen Hernandez-Blanco, MD, Brooks D. Cash, MD, FACG University of Texas Health Science Center at Houston, Houston, TX
Introduction: Multiple models already exist to prognosticate pancreatitis severity and mortality. However, most require invasive measurements and are cumbersome to use. The quick Sequential Organ Failure Assessment (SOFA) score (qSOFA) score is a bedside tool that may be useful in determining prognosis in patients with alcohol-induced acute pancreatitis (AAP). The goal of this study was to determine if the qSOFA and BISAP score assessed at admission is prognostic of severe clinical outcomes in AAP.
Methods: This is a retrospective, single center, cohort review study of 147 patients admitted to a community academic hospital in Houston, Texas, USA with the diagnosis of AAP. IRB approval was granted by the University of Texas Health Science Center at Houston, Houston, Texas, USA. Patient records were obtained from an electronic medical record system between December 1st, 2014 to July 1st, 2020. Patients were included if they were >18 years of age, had a history of alcohol consumption and had acute pancreatitis based on the Atlanta criteria. Receiver operator characteristics (ROC) and area under the curve (AUC) analysis was used to assess the diagnostic accuracy of the qSOFA and BISAP score on admission. Logistic regression was used to assess the odds of developing severe pancreatitis based on the Atlanta criteria and need for ICU admission, intubation or vasopressors based on the BISAP and qSOFA scoring systems.
Results: The qSOFA score ≥2 at admission to the hospital was found to be ≥94% specific and ≥33% sensitive while a BISAP score ≥3 at admission was found to be ≥96% specific and ≥20% sensitive for multiple clinical outcomes, including severe AAP and need for ICU admission, intubation or vasopressors. A qSOFA score ≥2 was prognostic of need for ICU admission by an adjusted odds ratio (aOR) of 48.5 (95% CI: 6.4-1,013.3; p< 0.001) and of severe AAP by an aOR of 35.3 (95% CI: 7.2-224.3; p< 0.001). A BISAP score ≥3 was prognostic of severe AAP by an aOR 7.1 (95% CI: 1.2-36.0; p< 0.05), need for ICU admission by an aOR 47.7 (95% CI: 6.9-487.1; p< 0.001), need for intubation by an aOR of 25.8 (95% CI: 3.5-238.4; p< 0.01) and need for vasopressors by an aOR of 14.2 (95% CI: 1.1-358.2; p< 0.05).
Discussion: At the time of admission, a BISAP score ≥3 or a qSOFA score ≥ 2 is highly specific and prognostic for multiple severe clinical outcomes of AAP. Since the qSOFA score has fewer variables than the BISAP score, it may be a more useful clinical tool to evaluate prognosis.
Figure: Figure 1: ROC-AUC curves showing the diagnostic accuracy of qSOFA score at admission (qSOFAADM) relative to the BISAP score at admission to diagnose clinical outcomes in alcoholic pancreatitis patients. (A) Overlayed ROC curves assessing severe pancreatitis. (B) Overlayed ROC curves assessing need for ICU admission. (C) Overlayed ROC curves assessing need for intubation. (D) Overlayed ROC curves assessing need for vasopressors.
Disclosures:
Jason Wagner indicated no relevant financial relationships.
Abraham Yu indicated no relevant financial relationships.
Victor Garcia-Rodriguez indicated no relevant financial relationships.
Wasay Mohajir indicated no relevant financial relationships.
Colin Goodman indicated no relevant financial relationships.
Andrew DuPont indicated no relevant financial relationships.
Ahmad Farooq indicated no relevant financial relationships.
Yllen Hernandez-Blanco indicated no relevant financial relationships.
Brooks Cash indicated no relevant financial relationships.
Jason Wagner, MD, Abraham Yu, MD, Victor Garcia-Rodriguez, MD, Wasay Mohajir, DO, Colin Goodman, BSc, Andrew DuPont, MD, Ahmad Farooq, MD, Yllen Hernandez-Blanco, MD, Brooks D. Cash, MD, FACG. P2107 - The Quick Sepsis-Related Organ Failure Assessment Score Is Prognostic of Pancreatitis Severity in Patients with Alcohol-Induced Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
