Wu Bechien U, Batech Michael, Quezada Michael, Lew Daniel, Fujikawa Kelly, Kung Jonathan, Jamil Laith H, Chen Wansu, Afghani Elham, Reicher Sonya, Buxbaum James, Pandol Stephen J
Center for Pancreatic Care, Division of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Am J Gastroenterol. 2017 Jul;112(7):1144-1152. doi: 10.1038/ajg.2017.114. Epub 2017 May 2.
Acute pancreatitis has a highly variable course. Currently there is no widely accepted method to measure disease activity in patients hospitalized for acute pancreatitis. We aimed to develop a clinical activity index that incorporates routine clinical parameters to assist in the measurement, study, and management of acute pancreatitis.
We used the UCLA/RAND appropriateness method to identify items for inclusion in the disease activity instrument. We conducted a systematic literature review followed by two sets of iterative modified Delphi meetings including a panel of international experts between November 2014 and November 2015. The final instrument was then applied to patient data obtained from five separate study cohorts across Southern California to assess profiles of disease activity.
From a list of 35 items comprising 6 domains, we identified 5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake. We applied the weighted scoring system across the 5 study cohorts comprising 3,123 patients. We identified several distinct patterns of disease activity: (i) overall there was an elevated score at baseline relative to discharge across all study cohorts, (ii) there were distinct patterns of disease activity related to duration of illness as well as (iii) early and persistent elevation of disease activity among patients with severe acute pancreatitis defined as persistent organ failure.
We present the development and initial validation of a clinical activity score for real-time assessment of disease activity in patients with acute pancreatitis.
急性胰腺炎病程变化很大。目前尚无广泛接受的方法来衡量因急性胰腺炎住院患者的疾病活动度。我们旨在开发一种纳入常规临床参数的临床活动指数，以辅助急性胰腺炎的测量、研究及管理。
我们采用加州大学洛杉矶分校/兰德适用性方法来确定疾病活动度评估工具中应纳入的项目。我们进行了系统的文献综述，随后在2014年11月至2015年11月期间召开了两组迭代式改良德尔菲会议，参会专家来自国际专家小组。然后将最终工具应用于从南加州五个独立研究队列获得的患者数据，以评估疾病活动度概况。
从包含6个领域的35项列表中，我们确定了5个参数纳入最终加权临床活动评分系统：器官功能衰竭、全身炎症反应综合征、腹痛、使用阿片类药物的需求以及口服耐受性。我们将加权评分系统应用于包含3123例患者的5个研究队列。我们确定了几种不同的疾病活动模式：（i）总体而言，所有研究队列中基线时的评分相对于出院时均升高，（ii）存在与病程相关的不同疾病活动模式，以及（iii）在定义为持续性器官功能衰竭的重症急性胰腺炎患者中，疾病活动度早期及持续升高。
我们展示了一种用于实时评估急性胰腺炎患者疾病活动度的临床活动评分的开发及初步验证。
