Frontiers in Physiology (Sep 2019)

A Multicenter, International Cohort Analysis of 1435 Cases to Support Clinical Trial Design in Acute Pancreatitis

  • Nelli Farkas,
  • Nelli Farkas,
  • Lilla Hanák,
  • Alexandra Mikó,
  • Alexandra Mikó,
  • Judit Bajor,
  • Patrícia Sarlós,
  • József Czimmer,
  • Áron Vincze,
  • Szilárd Gódi,
  • Dániel Pécsi,
  • Dániel Pécsi,
  • Péter Varjú,
  • Péter Varjú,
  • Katalin Márta,
  • Péter Jenő Hegyi,
  • Péter Jenő Hegyi,
  • Bálint Erőss,
  • Bálint Erőss,
  • Zsolt Szakács,
  • Tamás Takács,
  • László Czakó,
  • Balázs Németh,
  • Dóra Illés,
  • Balázs Kui,
  • Erika Darvasi,
  • Ferenc Izbéki,
  • Adrienn Halász,
  • Veronika Dunás-Varga,
  • László Gajdán,
  • József Hamvas,
  • Mária Papp,
  • Ildikó Földi,
  • Krisztina Eszter Fehér,
  • Márta Varga,
  • Klára Csefkó,
  • Imola Török,
  • Farkas Hunor-Pál,
  • Artautas Mickevicius,
  • Elena Ramirez Maldonado,
  • Ville Sallinen,
  • János Novák,
  • Ali Tüzün Ince,
  • Shamil Galeev,
  • Barnabás Bod,
  • János Sümegi,
  • Petr Pencik,
  • Attila Szepes,
  • Andrea Szentesi,
  • Andrea Szentesi,
  • Andrea Párniczky,
  • Andrea Párniczky,
  • Andrea Párniczky,
  • Péter Hegyi,
  • Péter Hegyi,
  • Péter Hegyi,
  • Péter Hegyi

DOI
https://doi.org/10.3389/fphys.2019.01092
Journal volume & issue
Vol. 10

Abstract

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BackgroundC-reactive protein level (CRP) and white blood cell count (WBC) have been variably used in clinical trials on acute pancreatitis (AP). We assessed their potential role.MethodsFirst, we investigated studies which have used CRP or WBC, to describe their current role in trials on AP. Second, we extracted the data of 1435 episodes of AP from our registry. CRP and WBC on admission, within 24 h from the onset of pain and their highest values were analyzed. Descriptive statistical tools as Kruskal–Wallis, Mann–Whitney U, Levene’s F tests, Receiver Operating Characteristic (ROC) curve analysis and AUC (Area Under the Curve) with 95% confidence interval (CI) were performed.ResultsOur literature review showed extreme variability of CRP used as an inclusion criterion or as a primary outcome or both in past and current trials on AP. In our cohort, CRP levels on admission poorly predicted mortality and severe cases of AP; AUC: 0.669 (CI:0.569–0.770); AUC:0.681 (CI: 0.601–0.761), respectively. CRP levels measured within 24 h from the onset of pain failed to predict mortality or severity; AUC: 0.741 (CI:0.627–0.854); AUC:0.690 (CI:0.586–0.793), respectively. The highest CRP during hospitalization had equally poor predictive accuracy for mortality and severity AUC:0.656 (CI:0.544–0.768); AUC:0.705 (CI:0.640–0.769) respectively. CRP within 24 h from the onset of pain used as an inclusion criterion markedly increased the combined event rate of mortality and severe AP (13% for CRP > 25 mg/l and 28% for CRP > 200 mg/l).ConclusionCRP within 24 h from the onset of pain as an inclusion criterion elevates event rates and reduces the number of patients required in trials on AP.

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