Who's at Risk? A Prognostic Model for Severity Prediction in Pediatric Acute Pancreatitis.

OBJECTIVES To validate and optimize a severity prediction model for acute pancreatitis (AP). Further, to examine blood urea nitrogen (BUN) level changes from admission as a severity predictor. STUDY DESIGN Patients from two hospitals were included for the validation model (Children's Hospital of the King's Daughters (CHKD) and Children's National Hospital). CHKD and Cincinnati Children's Hospital Medical Center data was used for analysis of BUN at 24-48 hours. RESULTS The validation cohort included 73 patients; 22 (30%) with either severe or moderately severe AP, combined into the all severe AP (SAP) group. SAP patients had higher BUN (P = 0.002) and lower albumin (P = 0.005). Admission BUN was confirmed as a significant predictor (P = 0.005) of SAP (AUROC 0.73, 95% CI 0.60 - 0.86). Combining BUN (P = 0.005) and albumin (P = 0.004) resulted in better prediction for SAP (AUROC 0.83, 95% CI 0.72 - 0.94). A total of 176 AP patients were analyzed at 24-48 hours; 39 (22%) met criteria for SAP. Patients who developed SAP had a significantly higher BUN (P < 0.001) after 24 hours. Elevated BUN levels within 24-48 hours were independently predictive of developing SAP (AUROC: 0.76, 95% CI: 0.66-0.85). Patients who developed SAP had a significantly smaller percent decrease in BUN from admission to 24-48 hours (P = 0.002). CONCLUSION We externally validated the prior model with admission BUN levels and further optimized it by incorporating albumin. We also found that persistent elevation of BUN is associated with development of SAP. Our model can be used to risk stratify AP patients on admission and again at 24 to 48 hours.