Chronic Pancreatitis Prognosis Score System Is Not Ready Yet

Abstract

We read with great interest the recently published study on Chronic Pancreatitis Prognosis Score reported by Beyer et al.1Beyer G. et al.Gastroenterology. 2017; 153: 1544-1554.e2Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar We concur that a model to assess disease severity or progression, or to predict patient outcomes is of significant importance. However, the scoring system could be improved. Admission to hospital and days spent in hospital in the next 12 months were adopted as surrogates for severity of disease in the present study. Chronic pancreatitis (CP) is a disease with a long-term chronic course, which characterized by inflammation and destruction of pancreatic acini and their replacement by fibrotic tissue. The course of CP often needs many years even decades of follow-up, and the conditions in 1 year cannot be persuasive. Hospital admissions for CP patients were mostly due to an acute pancreatitis attack or abdominal pain,2Rosch T. et al.Endoscopy. 2002; 34: 765-771Crossref PubMed Scopus (376) Google Scholar which can be quite changeable during the long course. With the fibrosis progressing, the severity and frequency of an acute pancreatitis attack will be decreased.3Acharya C. et al.Gastroenterology. 2013; 145: 466-475Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar With the pancreatic function “burning out” in the long term, the abdominal pain finally subsudes.4Ammann R.W. et al.Gastroenterology. 1999; 116: 1132-1140Abstract Full Text Full Text PDF PubMed Scopus (322) Google Scholar Thus, hospital admission in 1 year cannot represent the prognosis of CP or the risk for complications. As for the inclusion and exclusion criteria, autoimmune pancreatitis (AIP) is a distinct form of CP, and has good response to steroid treatment. AIP has unique histopathologic features, allowing it to be distinguished from other forms of CP.5Dite P, et al. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 2014;158:17–22.Google Scholar The etiology, mechanism, and prognosis of AIP are quite different from non-AIP CP. The AIP patients should be excluded from the present study. For prognostic factors in the present study, only 14 routine laboratory parameters, body mass index, worst pain severity within the last 7 days, and grading of pancreatic morphology based on the modified Cambridge Score were included. However, other parameters like smoking history, alcohol consumption, pancreatic pseudocysts, and biliary stricture were also important factors for CP prognosis,6Li B.R. et al.Gastrointest Endosc. 2016; 84: 69-78Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 7Hao L. et al.J Clin Gastroenterol. 2017 Sep 28; ([Epub ahead of print])Google Scholar and should be considered in the prognostic factors. Furthermore, treatment strategy and pancreatic stone clearance were also important to the progression and prognosis of CP. After clearance of pancreatic stones, 95.3% of patients reported an improvement in abdominal pain (71.3% cured and 24.0% improved).8Hu L.H. et al.Pancreas. 2016; 45: 298-305Crossref PubMed Scopus (37) Google Scholar As for the development and validation of the scoring system, the reliability could be improved. In the development of the scoring system, a linear correlation analysis was adopted. However, non–linearly associated factors may not be identified in the present analysis. This factor may affect the accuracy of the scoring system. In the internal and external validation part, the values for the Pearson and Kendal-Tau correlation analyses ranged from 0.24 to 0.48 and 0.13 to 0.36, respectively. This finding indicated only a weak to moderate correlation between the scoring system and hospital admissions. In conclusion, it is of great importance to develop a model for CP severity assessment and outcome prediction. The present scoring system could be improved in terms of surrogates for disease severity, inclusion and exclusion criteria, prognostic factors included, and statistical analysis. This step may help develop a more accurate and convenient scoring system. Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent CohortsGastroenterologyVol. 153Issue 6PreviewThe clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes. Full-Text PDF ReplyGastroenterologyVol. 154Issue 6PreviewWe thank Hao et al for commenting on the Chronic Pancreatitis Prognosis Score (COPPS).1 The aim for developing COPPS was to identify readily available parameters that correspond with the short- and medium-term clinical outcomes of chronic pancreatitis patients and to integrate them into a comprehensive scoring system. No such tool previously existed for the identification of patients at risk for an adverse disease course or for directing treatment. A prognosis score that would have predicted long-term endpoints was not the aim of the COPPS study. Full-Text PDF