title: A prognostic tool to predict severe acute pancreatitis in pediatrics.
abstract: OBJECTIVE
  Approximately 15-20% of pediatric patients with acute pancreatitis (AP) develop severe disease. Severity scoring tools were developed for adult patients, but have limitations when applied in children. We aimed to identify early predictors of severe acute pancreatitis (SAP) on hospital admission for early risk stratification of patients.
  
  
  METHODS
  Retrospective review of AP admissions was conducted. The derivation cohort included cases at Cincinnati Children's Hospital Medical Center (CCHMC) between 2009 and 2013. Clinical data collected during the first 24 h of admission were analyzed and a predictive model was derived through statistical analysis. The performance of the model was evaluated in a validation cohort from 2 more institutions other than CCHMC.
  
  
  RESULTS
  In the derivation cohort 19% of the 284 admissions were SAP. A generalized linear mixed effect model analysis revealed that lipase, albumin and white blood count (WBC) play a role in the development of SAP (area under the receiver operating curve (AUROC 0.76)). In the validation cohort of 165 AP cases, SAP ranged from 8 to 20% at the three institutions. Performance of the model in this cohort was comparable to the derivation model (AUROC 0.77). There were 369 encounters in the combined derivation and validation pool (AUROC 0.76).
  
  
  CONCLUSIONS
  The prognostic severity tool with 3 variables (lipase, albumin, and WBC) obtained within 24 h of admission can be applied to predict SAP in pediatric patients.
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Flora K
authors.initials: FK
authors.lastname: Szabo
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Hornung
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: Judy-April
authors.initials: JA
authors.lastname: Oparaji
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Rabea
authors.initials: R
authors.lastname: Alhosh
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: Sohail Z
authors.initials: SZ
authors.lastname: Husain
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Quin Y
authors.initials: QY
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Palermo
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Tom K
authors.initials: TK
authors.lastname: Lin
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jaimie D
authors.initials: JD
authors.lastname: Nathan
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Podberesky
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Lowe
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Fei
authors.affiliation: Division of Gastroenterology Hepatology and Nutrition; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: maisam.haija@cchmc.org.
authors.forename: Maisam
authors.initials: M
authors.lastname: Abu-El-Haija
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D016014:Linear Models; D008049:Lipase / Q000097:blood; D008297:Male; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis*; D010372:Pediatrics; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D008049:Lipase
keywords: Derivation cohort; Pediatric pancreatitis; Prognostic markers; Prognostic model; Severe acute pancreatitis; Validation cohort