Admission risk factors and predictors of moderate or severe pediatric acute pancreatitis: A systematic review and meta-analysis.
Front Pediatr
; 10: 947545, 2022.
Article
in En
| MEDLINE
| ID: mdl-36245710
ABSTRACT
Introduction:
Pediatric acute pancreatitis (PAP) has an increasing incidence and is now estimated to be almost as common as in adults. Up to 30% of patients with PAP will develop moderate or severe disease course (M/SPAP), characterized by organ failure, local or systemic complications. There is still no consensus regarding on-admission severity prediction in these patients. Our aim was to conduct a systematic review and meta-analysis of available predictive score systems and parameters, and differences between on-admission parameters in mild and M/SPAP.Methods:
We conducted a systematic search on the 14th February, 2022 in MEDLINE, Embase and CENTRAL. We performed random-effects meta-analysis of on-admission differences between mild and M/SPAP in laboratory parameters, etiology, demographic factors, etc. calculating risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) and created forest plots. For the meta-analysis of predictive score systems, we generated hierarchical summary receiver operating characteristic curves using a bivariate model. Chi-squared tests were performed and I2 values calculated to assess statistical heterogeneity.Results:
We included 44 studies - mostly retrospective cohorts - in our review. Among predictive score systems examined by at least 5 studies, the modified Glasgow scale had the highest specificity (91.5% for values ≥3), and the Pediatric Acute Pancreatitis Severity score the highest sensitivity (63.1% for values ≥3). The performance of other proposed score systems and values were summarized. Traumatic (RR 1.70 95% CI 1.09-2.67) and drug-induced (RR 1.33 95% CI 0.98-1.87) etiologies were associated with a higher rate of M/SPAP, while anatomical (RR 0.6195% CI 0.38-0.96) and biliary (RR 0.72 95% CI 0.53-0.99) PAP tended to be less severe.Discussion:
Many predictive score systems were proposed to assess the possibility of M/SPAP course. The most commonly used ones exhibit good specificity, but subpar sensitivity. Our systematic review provides a rigorous overview of predictive options assessed thus far, that can serve as a basis for future improvement of scores via the addition of parameters with a better observed sensitivity e.g., lipase exceeding 7-times the upper threshold, hemoglobin, etc. The addition of etiological factors is another possibility, as they can herald a more severe disease course. Systematic review registration https//www.crd.york.ac.uk/prospero/display_record.php?RecordID=307271, PROSPERO, identifier CRD42022307271.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Language:
En
Journal:
Front Pediatr
Year:
2022
Document type:
Article
Affiliation country:
Publication country:
CH
/
SUIZA
/
SUÍÇA
/
SWITZERLAND