A Clinical Model for the Early Diagnosis of Acute Pancreatitis in the Emergency Department
SUPPLEMENTAL DIGITAL CONTENT
SUPPLEMENTARY TABLE 1. Distribution of Acute Pancreatitis and 54 Candidate Predictors in Derivation and Validation Sets
Candidate Predictor* Derivation Set (n = 212)
Validation Set (n = 107)
P
Acute pancreatitis 122 (57) 60 (56) 0.81
Demographic factors
Age, y 49 (35–65) 51 (40–60) 0.57
Sex, male 96 (45) 42 (39) 0.34
Race 0.39
White 121 (57) 57 (53) -
Black 42 (20) 26 (24) -
Hispanic 35 (17) 13 (12) -
Other 14 (7) 11 (10) -
Medical comorbidities/history
Charlson Cormorbidity Index 1 (0–3) 1 (0–3) 0.09
Prior AP 59 (28) 31 (29) 0.90
No. of prior AP episodes 0 (0–1) 0 (0–1) 0.91
Chronic pancreatitis 18 (8) 11 (10) 0.68
Pancreatic tumor 8 (4) 5 (5) 0.77
Autoimmune pancreatitis† 2 (1) 0 (0) 0.55
Hereditary AP† 1 (0) 1 (1) 1.00
Cholelithiasis 37 (17) 22 (21) 0.54
Biliary colic† 6 (3) 3 (3) 1.00
Cholecystitis 10 (5) 7 (7) 0.59
Cholangitis† 3 (1) 1 (1) 1.00
Choledocholithiasis 7 (3) 2 (2) 0.72
Cholecystectomy 44 (21) 17 (16) 0.37
Hypertriglyceridemia† 5 (2) 5 (5) 0.31
Hypercalcemia† 1 (0) 0 (0) 1.00
Abdominal surgery in prior 2 months‡ 22 (10) 15 (14) 0.36
ERCP in prior 1 week† 7 (3) 1 (1) 0.28
Medication change in prior 2 weeks 29 (14) 6 (6) 0.04§
Family history of AP† 0 (0) 3 (3) 0.04§
Lifestyle factors
Smoking (ever) 85 (40) 35 (37) 0.22
Smoking (current) 47 (22) 18 (17) 0.30
Alcohol use (current) 74 (35) 34 (32) 0.62
Symptoms and signs
Time from onset to presentation, days 2 (0–4) 2 (0–5) 0.65
Pain severity at presentation, out of 10 0.14
Mild (0–3) 56 (26) 18 (17) -
Moderate (4–6) 30 (14) 15 (14) -
SUPPLEMENTARY TABLE 1. Distribution of Acute Pancreatitis and 54 Candidate Predictors in Derivation and Validation Sets
Candidate Predictor* Derivation Set (n = 212)
Validation Set (n = 107)
P
Upper abdominal 89 (42) 40 (37) 0.47
Radiating to back 77 (36) 30 (28) 0.17
Progressively worsening severity 35 (17) 22 (21) 0.44
Constant in presence 50 (24) 25 (24) 1.00
Similar previous symptoms 71 (33) 34 (32) 0.80
Surgical/rigid abdomen† 1 (0) 0 (0) 1.00
Interferes with sleep 26 (12) 8 (7) 0.25
Interferes with eating 53 (25) 33 (31) 0.29
Other symptoms/signs
Nausea 136 (64) 76 (71) 0.26
Vomiting 103 (46) 61 (57) 0.19
Diarrhea/loose stools 48 (23) 27 (25) 0.68
SIRS at presentation 55 (26) 29 (27) 0.89
Laboratory studies‖
Lipase, U/L 0.90
≥3 – <10x ULN (180–599) 114 (54) 56 (52) -
≥10 – <20x ULN (600–1199) 39 (18) 22 (21) -
≥20 ULN (≥1200) 59 (28) 29 (27) -
Alanine aminotransferase >50 U/L 62 (29) 28 (26) 0.60
Aspartate aminotransferase >50 U/L 64 (30) 32 (30) 1.00
Alkaline phosphatase >130 U/L 66 (31) 24 (22) 0.11
Total bilirubin, mg/dL 0.71
Normal (0–1) 160 (75) 80 (75) -
Moderately elevated (1.8–4) 38 (18) 22 (21) -
Severely elevated (>4) 14 (7) 5 (5) -
White blood cell <4 or >12 x103 cells/mm3 64 (30) 32 (30) 1.00
Hematocrit, % 0.50
Low (<36) 76 (36) 34 (32) -
Normal (36–48) 132 (62) 69 (64) -
Elevated (>48) 4 (2) 4 (4) -
Blood urea nitrogen >23 mg/dL 45 (21) 20 (19) 0.66
Creatinine >1.2 mg/dL 49 (23) 24 (22) 1.00
Albumin <3.5 g/dL 38 (18) 12 (11) 0.14
Lactate >2.2 mmol/L 18 (8) 19 (18) 0.02§
Values are n (%) for categorical variables and median (IQR) for continuous variables.
*Missing dichotomous “symptoms and signs” assumed as absent. Missing “pain severity at presentation” and laboratory variables imputed with statistical mode of individuals with and without AP. Missing “time from onset to presentation” variables imputed with statistical mean.
†Excluded from univariable analysis due to prevalence <5% in both AP and non-AP cohorts.
‡ See Supplementary Table 3.
§P < 0.05 between derivation and validation sets.
‖ Initial laboratory values used. Cut-offs based on institutional standards.
AP indicates acute pancreatitis; ED, emergency department; ERCP, endoscopic retrograde cholangiopancreatography; IQR, interquartile range; SIRS, systemic inflammatory response syndrome; ULN, upper limit of normal.
SUPPLEMENTARY TABLE 2. Derivation of the Point-Based Scoring Model Candidate Variable Category Reference
Value βi βi (Wij – WiREF) Pointsij = βi (Wij - WiREF)/B
No. of prior AP episodes 1.1595
0 0 = W4REF 0 0
1 1 1.1595 1
2 2 2.3190 2
3 3 3.4786 3
≥4* 4 4.6391 4
History of cholelithiasis 1.9207
No 0 = W3REF 0 0
Yes 1 1.9207 2
Abdominal surgery in prior 2 months
-1.8196
No 0 = W5REF 0 0
Yes 1 -1.8196 -2
Epigastric pain 2.6323
No 0 = W1REF 0 0
Yes 1 2.6323 2
Progressively worsening pain severity
1.5368
No 0 = W2REF 0 0
Yes 1 1.5368 1
Time from onset to presentation, d
-0.1217
<1 0 = W6REF 0 0
≥1 – <3 2 -0.2434 0
≥3 – <5 4 -0.4868 0
≥5 – <7 6 -0.7302 -1
≥7† 10 -1.2170 -1
Pain severity at
presentation (moderate)‡
2.3082
No 0 = W7REF 0 0
Yes 1 2.3082 2
Pain severity at presentation (severe)‡
3.5863
No 0 = W8REF 0 0
Yes 1 3.5863 3
Serum lipase (≥10x – <20x ULN)§
0.6615
No 0 = W9REF 0 0
Yes 1 0.6615 1
Serum lipase (≥20x ULN)§
1.8191
No 0 = W10REF 0 0
Yes 1 1.8191 2
*Range 0–6 episodes; to determine reference value for last category, the median value was used.
†Range 0–48 days; to determine reference value for last category, the median value was used.
‡Using pain severity (mild) as reference.
§Using serum lipase (≥3x – <10x ULN) as reference.
AP indicates acute pancreatitis; βi, regression-coefficient for predictor (i); B, points constant which reflects regression units associated with each prior episode of AP (1.1595); ULN, upper limit of normal; Wij, reference
SUPPLEMENTARY TABLE 3. Estimate of AP Risk Using Point-Based Scoring Model*
Point Total Estimate of AP Risk Point Total Estimate of AP Risk
-4 0.0001 7 0.9744
-3 0.0004 8 0.9918
-2 0.0011 9 0.9974
-1 0.0036 10 0.9992
0 0.0112 11 0.9997
1 0.0350 12 0.9999
2 0.1035 13 0.9999
3 0.2691 14 0.9999
4 0.5400 15 0.9999
5 0.7892 16 0.9999
6 0.9227 17 0.9999
*𝑃(risk of AP) = 𝑒(𝑋𝛽) 𝑒(𝑋𝛽) + 1⁄ , where 𝑋𝛽 ≈ 1.1595 × point total − 4.4774.
SUPPLEMENTARY TABLE 4: Abdominal Surgeries in Derivation and Validation Sets
Surgery* Derivation Set (n = 22) Validation Set (n = 15)
Bowel resection/bypass 5 (23) 4 (27)
Cholecystectomy 5 (23) 1 (7)
Gastric sleeve 4 (18) 2 (13)
Gastrostomy/enterostomy tube 2 (9) 1 (7)
Endoscopic necrosectomy/cyst drainage 2 (9) 2 (13)
Lysis of adhesions 2 (9) 0
Whipple 0 2 (13)
Other 2 (9) 3 (20)
Values are expressed as n (%).
* Within prior 2 months via open, laparoscopic, or endoscopic approach.
