Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study

Use of Structured Template and Reporting Tool for Real-World Evidence for Critical Appraisal of the Quality of Reporting of Real-World Evidence Studies: A Systematic Review

OBJECTIVES

Real-world evidence (RWE) studies are increasingly being used to support healthcare decisions. Various frameworks, tools, and checklists exist for ensuring quality of real-world data, designing robust studies, and assessing potential for bias. In January 2021, Structured Template and Reporting Tool for RWE (STaRT-RWE) was released to further reduce ambiguity, assumptions, and misinterpretation while planning, implementing, and reporting RWE studies of the safety and effectiveness of treatments. The objective of this study was to identify gaps in the reporting quality of published RWE studies by using this template for critical appraisal.

METHODS

Two reviewers conducted a keyword search on PubMed for free-full-text research articles using real-world data, RWE design, and safety with or without effectiveness outcomes of a medicinal product or intervention in humans of any age or gender, published in English between January 13, 2021, and January 13, 2022. Assessment of risk of bias was done using Assessment of Real-World Observational Studies critical appraisal tool. Deficiencies in methods and findings as per STaRT-RWE template were reported as frequencies.

RESULTS

A total of 54 of 2374 retrieved studies were included in the review. Based on the STaRT-RWE template, the studies inadequately reported empirically defined covariates, power and sample size calculation, attrition, sensitivity analyses, index date (day 0) defining criterion, predefined covariates, outcome, metadata about data source and software, objective, inclusion and exclusion criteria, analysis specifications, and follow-up.

CONCLUSIONS

The use of STaRT-RWE template along with its tables, design diagram, and library of published studies has a potential of improving robustness of RWE studies.

Computed tomography characteristics of acute pancreatitis based on different etiologies at different onset times: a retrospective cross-sectional study

BACKGROUND

The clinical characteristics and imaging findings of acute pancreatitis (AP) are different across the various etiologies, the results are conflicting, and their time from symptom onset to imaging varies. The imaging findings of different etiologies at different onset times are unclear. This study aimed to investigate the computed tomography (CT) characteristics of AP based on different etiologies at different onset times.

METHODS

Patients who underwent plain and contrast-enhanced computed tomography (CECT) for the first attack of AP in 3 hospitals (Affiliated Hospital of North Sichuan Medical College, Chinese People's Liberation Army Western Theater General Hospital, and Suining Central Hospital) from 2015 to 2019 were recruited. According to the different etiologies of AP, the patients were divided into 5 subgroups: biliary AP (n=591), alcoholic AP (n=267), hypertriglyceridemic AP (n=258), mixed causes subgroups (n=199), and "other/idiopathic" AP (n=545). According to the time from onset to CT examination (e.g., 1-3, 4-7, 8-14, 15-28, and >28 days), the onset time was divided into 5 respective phases (I-V). The CT characteristics and clinical and laboratory features were retrospectively reviewed and compared among the different etiology subgroups and onset time.

RESULTS

The positive rate of CT findings in AP diagnosis based on CECT was 96.7% (1,860/1,924). Necrotizing pancreatitis (NP) occurred in 33.2% (617/1,860) of AP patients with positive CECT findings. Among patients with NP, local complications and severe AP of the modified CT severity index (MCTSI) increased over time in those with biliary AP from 17.1%, 25.2%, and 20.0% in Phase I to 42.9%, 44.0%, and 39.7% in Phase IV [all P<0.05, 95% confidence interval (CI): 0.15 to 0.52, 0.28 to 0.63, and 0.18 to 0.82, respectively]. In contrast, NP, local complications and severe AP of MCTSI in those with hypertriglyceridemic AP decreased over time from 24.3%, 22.5%, and 22.7% in Phase I to 1.3%, 1.2%, and 1.9% in Phase V (all P<0.05, 95% CI: 3.20 to 181.74, 3.31 to 175.74, and 2.00 to 120.78, respectively).

CONCLUSIONS

The proportion of NP was 33.2% of positive CECT findings. There may be differences in the CT and clinical manifestations of the different etiologies, and those differences may be related to the onset time.

Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC (p = 0.004), GLU (p = 0.008), LDH (p < 0.001), Ca²⁺ (p = 0.006), AST (p = 0.009), PLT (p = 0.041), IL-6 (p < 0.001), IL-10 (p < 0.001), and TNF-α (p < 0.001). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score (p < 0.001), APACHE II score (p < 0.001), Marshall score (p < 0.001), and BISAP score (p < 0.001). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 (p = 0.0024) and 0.727 (p = 0.0373). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.