Introduction and Validation of a Novel Acute Pancreatitis Digital Tool: Interrogating Large Pooled Data From 2 Prospectively Ascertained Cohorts
Pedram Paragomi, From the Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center.
Daniel M. Spagnolo, Ariel Precision Medicine, Pittsburgh, PA.
Cameron R. Breze, Ariel Precision Medicine, Pittsburgh, PA.
Amir Gougol, From the Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center.
Rupjyoti Talukdar, Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad.
Rakesh Kochhar, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh.
Mahesh Kumar Goenka, Department of Gastroenterology, Apollo Gleneagles Hospitals Kolkata, Kolkata, India.
Aiste Gulla, Department of Gastroenterology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Jose A. Gonzalez, Department of Gastroenterology, Universidad Autónoma de Nueva León, Monterrey, Mexico.
Vikesh K. Singh, Division of Gastroenterology, Department of Medicine, John Hopkins Medical Institutions, Baltimore, MD.
Miguel Ferreira, Department of Gastroenterology, Hospital Nacional de Itauguá, Itaugua, Paraguay.
Tyler Stevens, Department of Medicine, Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH.
Sorin T. Barbu, Department of Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Haq Nawaz, Department of Gastroenterology, Eastern Maine Medical Center, Bangor, ME.
Silvia C. Gutierrez, Department of Gastroenterology, Hospital Nacional "Profesor Alejandro Posadas", Buenos Aires, Argentina.
Narcis O. Zarnescu, Department of Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Bucharest, Romania.
Livia Archibugi, Department of Pancreato-Biliary Endoscopy and Endosonography, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
Jeffrey J. Easler, Division of Gastroenterology, Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN.
Konstantinos Triantafyllou, Department of Medicine, Attikon University General Hospital, Athens, Greece.
Mario Pelaez-Luna, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad\Autónoma de Mexico, Mexico City, Mexico.
Shyam Thakkar, Department of Gastroenterology, West Virginia University, Morgantown, WV.
Carlos Ocampo, Department of Surgery, Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina.
Enrique de-Madaria, Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
Gregory A. Cote, Division of Gastroenterology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
Bechien U. Wu, Division of Gastroenterology, Department of Medicine, Kaiser Permanente, Pasadena, CA.
Ioannis Pothoulakis, From the Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center.
Mark Haupt, Ariel Precision Medicine, Pittsburgh, PA.
David C. Whitcomb, From the Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center.
Georgios I. Papachristou, Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University, Wexner Medical Center, Columbus, OH.
Abstract
OBJECTIVES: Acute pancreatitis (AP) is a sudden onset, rapidly evolving inflammatory response with systemic inflammation and multiorgan failure (MOF) in a subset of patients. New highly accurate clinical decision support tools are needed to allow local doctors to provide expert care. METHODS: Ariel Dynamic Acute Pancreatitis Tracker (ADAPT) is a digital tool to guide physicians in ordering standard tests, evaluate test results and model progression using available data, propose emergent therapies. The accuracy of the severity score calculators was tested using 2 prospectively ascertained Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience cohorts (pilot University of Pittsburgh Medical Center, n = 163; international, n = 1544). RESULTS: The ADAPT and post hoc expert-calculated AP severity scores were 100% concordant in both pilot and international cohorts. High-risk criteria of all 4 severity scores at admission were associated with moderately-severe or severe AP and MOF (both P < 0.0001) and prediction of no MOF was 97.8% to 98.9%. The positive predictive value for MOF was 7.5% to 14.9%. CONCLUSIONS: The ADAPT tool showed 100% accuracy with AP predictive metrics. Prospective evaluation of ADAPT features is needed to determine if additional data can accurately predict and mitigate severe AP and MOF.
