Clinical evaluation of the M-ANNHEIM classification: Development of the M-ANNHEIM-Surgery-Score as a new tool to monitor patients with chronic pancreatitis.
Z Gastroenterol
; 56(12): 1481-1490, 2018 Dec.
Article
em En
| MEDLINE
| ID: mdl-30536253
ABSTRACT
OBJECTIVES:
The M-ANNHEIM classification of chronic pancreatitis (CP) stratifies degrees of disease severity according to the M-ANNHEIM-Severity-Score. We aimed to demonstrate the clinical usefulness of the M-ANNHEIM-Severity-Score in quantifying and predicting the frequency of pancreatic surgery, and to establish the M-ANNHEIM-Surgery-Score as a simplified system for patient surveillance regarding the demand of pancreatic surgery.METHODS:
We performed a retrospective, cross-sectional study with 741 CP patients (Mannheim/Germany, nâ=â537; Gießen/Germany, nâ=â100; Donetsk/Ukraine, nâ=â104) categorized according to the M-ANNHEIM classification.RESULTS:
We observed a significantly higher M-ANNHEIM-Severity-Score in patients that were classified within 7 days preceding pancreatic surgery than in individuals that did not require surgery (pâ<â0.001, Mann-Whitney-U-test). Using a logistic regression analysis with all variables of the M-ANNHEIM-Severity-Score, we established the M-ANNHEIM-Surgery-Score as a simplified new tool to identify patients that may require surgery. A receiver operating characteristic-analysis revealed a cut-off-value of 9 points within the M-ANNHEIM-Surgery-Score to identify these individuals (sensitivity 78.7â%, specificity 91â%). Based on the M-ANNHEIM-Surgery-Score, we defined three categories for demand of surgery with frequencies of pancreatic operations of 1.6â% (nâ=â7/440) in the "Baseline-Demand"-category, 7â% (nâ=â12/172) in the "Low-Demand"-category (pâ<â0.0001, Chi-square-test, OR 4.6, Confidence Interval (CI) 1.8â-â12), and 54â% (nâ=â70/129) in the "High-Demand"-category (pâ<â0.0001, OR 73, CI 32â-â167). Patients that were categorized for the "High-Demand"-category, but were not operated on, had a significantly increased ratio of clinical features that hamper performance of surgery (pâ<â0.001, Chi-square-test).CONCLUSIONS:
The M-ANNHEIM-Surgery-Score represents a useful tool to monitor patients with CP and to estimate the demand of surgery in CP.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Índice de Gravidade de Doença
/
Pancreatite Crônica
Tipo de estudo:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
Z Gastroenterol
Ano de publicação:
2018
Tipo de documento:
Article