The Pancreatitis Activity Scoring System Predicts Post-Intervention Outcomes and Early Readmission in Patients With Infected Pancreatic Necrosis

INTRODUCTION: The Pancreatitis Activity Scoring System (PASS) score comprises of five weighted components (organ failure, SIRS, abdominal pain, opiate requirement, and oral intake), and has been externally validated to predict readmission and development of moderate to severe acute pancreatitis (AP). Our aim was to study the predictive role of PASS score (PS) in patients with suspected or confirmed infected pancreatic necrosis (IPN). METHODS: Consecutive inpatients with IPN requiring intervention treated at UCSF January 2011 through January 2019 were identified. PSs were calculated at admission, prior to and 72-hours after each intervention, and at discharge. Multivariable logistical regression was used to assess the relationship between PS and various outcomes; development of multi-organ failure (MOF), need for early re-intervention (<1 week) and 30-day readmission. RESULTS: 67 patients (median age 54) were identified; organ failure rates were 55% respiratory, 60% shock, and 72% renal. Median admission PS was 440 (IQR 345–605). 38 patients underwent surgical therapy and 29 underwent step-up endoscopic therapy; median admission PSs were similar (405 vs 460, P = 0.62). A 20% reduction in the baseline PS at 72 hours post-intervention was associated with a lower rate of MOF development (aOR 0.01; 95% CI: 0.001–0.13, P < 0.001) and early re-intervention (aOR 0.03; 95% CI: 0.003–0.16, P < 0.001). The 72-hour post-intervention PS (AUC = 0.88) was superior to admission PS, post-intervention SIRS or pain score (AUC = 0.66, 0.51, 0.43, respectively P < 0.001) for the prediction of development of MOF. Discharge PS < 250 was associated with 89% lower odds of 30-day readmission (aOR 0.11; 95% CI: 0.03–0.46, P = 0.002) and the discharge PS (AUC = 0.88, Figure 1) had superior prediction of readmission compared to discharge pain or admission PASS scores (AUC = 0.66 and 0.60, respectively P < 0.001). CONCLUSION: In this retrospective cohort study, the PASS score was associated with post-intervention clinical outcomes and early readmission suggesting it is a valid measure of disease activity in patients with infected pancreatic necrosis. Prospective studies are needed to further validate these results.