November 22, 2016

AP-CAI Scoring System for Acute Pancreatitis after Hospital Discharge Potentially Useful

By cancerconnect

A new scoring system to predict patient readmission within 30 days after a hospital stay for acute pancreatitis was presented at the 2016 American College of Gastroenterology (ACG) Annual Scientific Meeting.

Acute pancreatitis usually occurs after an alcoholic binge or from gallstones. Patients present with severe abdominal pain in the upper mid abdomen usually accompanied with nausea and vomiting. Most attacks don’t lead to complications; however, a portion of people will require intensive medical care or develop long-term pancreatitis.

In this multicenter study, Michael Quezada, MD, from LAC+USC Medical Center, Los Angeles, and his team used the AP-CAI (Acute Pancreatitis Clinical Activity Index) as a clinical assessment tool to establish a threshold score for the purpose of accurately discharging a patient after a hospital stay. To achieve this result, peak and total measurements were used for calculations. The index measured organ failure, SIRS, abdominal pain, morphine equivalent dose, and toleration of solid diet.

The study looked at 322 patients admitted to the LAC+USC Medical Center with acute pancreatitis between March 2015 and March 2016:  56% were male, 80% Hispanic, with the mean age at 46 years; 149 cases due to gallstones, 84 cases due to alcohol, and 99 cases from something else. 18% had a history of admission for acute pancreatitis.

The primary outcome was determined by readmission to the hospital within 30 days after discharge for worsening or smoldering symptoms of pancreatitis, symptoms and complications due to pancreatitis management, or complications due to pancreatitis therapy.

Out of 114 patients who had an AP-CAI score >50, 25 were readmitted and 13 presented to the ER. Of the 218 patients with a discharge AP-CAI score <50, 4 were readmitted and 3 presented to the ER.

Of those that were readmitted within 30 days, 72% presented with smoldering or worsening pancreatitis symptoms, 4 patients presented with pancreatitis complications due to management, and 4 patients with complication due to therapy. For the 16 patients who were admitted to the ER, all had smoldering or worsening symptoms.

Quezada said,  “AP-CAI score greater than 50 at time of discharge is strongly associated with inpatient readmission and presentation to the ED within 30 days of discharge from and admission for acute pancreatitis after controlling for age, race, gender and disease severity.”

After further analysis, research shows patients with an AP-CAI score >50 were nine times more likely to be readmitted; patients with previous admission were 3 times as likely to be readmitted; and after a multivariable analysis, patients with a score >50 were ten times as likely to be readmitted, and previous admissions were likely to be readmitted. As for the patients who presented to the ER, only the AP-CAI core >50 was a predictor, making these patients eight to nine times more likely for readmission under different variables.

“What the AP-CAI offers is the ability to objectively measure state of illness in real time and to mark their score trajectory across their hospitalization. Perhaps some of the parameters are more reflective of underlying disease activity as opposed to previous scoring parameters,” Quezada said.

Reference: Quezada M, et al. Abstract #4. Presented at American College of Gastroenterology Annual Scientific Meeting. October 17-19, 2016; Las Vegas.

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