A new preprocedural predictive risk model for post-endoscopic retrograde cholangiopancreatography pancreatitis: The SuPER model.

IF 6.4 1区生物学 Q1 BIOLOGY

eLife Pub Date : 2025-01-17 DOI:10.7554/eLife.101604

Mitsuru Sugimoto, Tadayuki Takagi, Tomohiro Suzuki, Hiroshi Shimizu, Goro Shibukawa, Yuki Nakajima, Yutaro Takeda, Yuki Noguchi, Reiko Kobayashi, Hidemichi Imamura, Hiroyuki Asama, Naoki Konno, Yuichi Waragai, Hidenobu Akatsuka, Rei Suzuki, Takuto Hikichi, Hiromasa Ohira

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引用次数: 0

Abstract

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a severe and deadly adverse event following ERCP. The ideal method for predicting PEP risk before ERCP has yet to be identified. We aimed to establish a simple PEP risk score model (SuPER model: Support for PEP Reduction) that can be applied before ERCP.

Methods: This multicenter study enrolled 2074 patients who underwent ERCP. Among them, 1037 patients each were randomly assigned to the development and validation cohorts. In the development cohort, the risk score model for predicting PEP was established via logistic regression analysis. In the validation cohort, the performance of the model was assessed.

Results: In the development cohort, five PEP risk factors that could be identified before ERCP were extracted and assigned weights according to their respective regression coefficients: -2 points for pancreatic calcification, 1 point for female sex, and 2 points for intraductal papillary mucinous neoplasm, a native papilla of Vater, or the pancreatic duct procedures (treated as 'planned pancreatic duct procedures' for calculating the score before ERCP). The PEP occurrence rate was 0% among low-risk patients (≤0 points), 5.5% among moderate-risk patients (1-3 points), and 20.2% among high-risk patients (4-7 points). In the validation cohort, the C statistic of the risk score model was 0.71 (95% CI 0.64-0.78), which was considered acceptable. The PEP risk classification (low, moderate, and high) was a significant predictive factor for PEP that was independent of intraprocedural PEP risk factors (precut sphincterotomy and inadvertent pancreatic duct cannulation) (OR 4.2, 95% CI 2.8-6.3; p<0.01).

Conclusions: The PEP risk score allows an estimation of the risk of PEP prior to ERCP, regardless of whether the patient has undergone pancreatic duct procedures. This simple risk model, consisting of only five items, may aid in predicting and explaining the risk of PEP before ERCP and in preventing PEP by allowing selection of the appropriate expert endoscopist and useful PEP prophylaxes.

Funding: No external funding was received for this work.

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一种新的内镜后逆行胆管胰腺炎手术前预测风险模型：SuPER模型。

背景：内镜下逆行胰胆管造影（ERCP）后胰腺炎（PEP）是ERCP后严重和致命的不良事件。在ERCP之前预测PEP风险的理想方法尚未确定。我们的目的是建立一个简单的PEP风险评分模型（SuPER model: Support for PEP Reduction），可以应用于ERCP之前。方法：这项多中心研究纳入了2074例接受ERCP的患者。其中，1037名患者被随机分配到开发和验证队列。在发展队列中，通过logistic回归分析，建立预测PEP的风险评分模型。在验证队列中，对模型的性能进行了评估。结果：在发展队列中，提取了ERCP前可识别的5个PEP危险因素，并根据各自的回归系数分配权重：胰腺钙化-2分，女性1分，导管内乳头状粘液瘤，原生Vater乳头或胰管手术（作为“计划胰管手术”计算ERCP前的评分）2分。低危（≤0分）患者PEP发生率为0%，中危（1 ~ 3分）患者PEP发生率为5.5%，高危（4 ~ 7分）患者PEP发生率为20.2%。在验证队列中，风险评分模型的C统计量为0.71 (95% CI为0.64-0.78)，认为可以接受。PEP风险分类（低、中、高）是PEP的重要预测因素，独立于术中PEP风险因素（预切括约肌切开术和无意胰管插管）(OR 4.2, 95% CI 2.8-6.3；结论：PEP风险评分可以评估ERCP前PEP的风险，无论患者是否接受过胰管手术。这个简单的风险模型，只有五个项目，可以帮助预测和解释ERCP之前PEP的风险，并通过选择合适的内窥镜专家和有用的PEP预防措施来预防PEP。经费：本工作未收到外部经费。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

eLife BIOLOGY-

CiteScore

12.90

自引率

3.90%

发文量

3122

审稿时长

17 weeks

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