Simple risk score to predict the likelihood of a positive EUS in idiopathic acute pancreatitis

      Background and Aims

      We sought to derive a risk score, DORM65, of known variables to predict the likelihood of a positive EUS in patients with idiopathic acute pancreatitis (IAP).


      A retrospective cohort study of 180 patients with IAP was performed across 3 tertiary care centers between January 2018 and December 2021. Multivariate logistic regression modeling was performed to predict a positive EUS. Accuracy of the models was assessed by the area under the receiver-operating characteristic curve (AUROCC).


      The diagnostic yield of EUS was 58.9% (95% confidence interval [CI], 51.7-66.1). The DORM65 scores of 5 predictors present before EUS with the best discrimination were a delayed EUS (defined as ≥82 days from the last episode of AP), obesity, not having had a repeated transabdominal US, male sex, and age ≥65 years at the time of EUS. For those at the lowest risk score group, the positive EUS rate was 13.0% compared with 100% in those at the highest risk group (relative risk, 7.67; P < .001). A score of 3 or more had a positive predictive value of 86.0% with a sensitivity of 34.9% and specificity of 91.9%. The model had a high predictive accuracy (AUROCC, .774; 95% CI, .707-.841). Adding 3 additional predictors (no cholecystectomy, no MRCP, and a single episode of AP) did not increase the accuracy significantly (AUROCC, .805; 95% CI, .742-.867).


      DORM65 is easily calculated and accurately predicts a positive EUS in patients with IAP. Further validation is needed.

      Graphical abstract


      AP (acute pancreatitis), AUROCC (area under the receiver-operating characteristic curve), aOR (adjusted odds ratio), CI (confidence interval), IAP (idiopathic acute pancreatitis), IRAP (idiopathic recurrent acute pancreatitis), NAFPD (nonalcoholic fatty pancreas disease), OR (odds ratio), TUS (transabdominal US)
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        • Yadav D.
        • Lowenfels A.B.
        The epidemiology of pancreatitis and pancreatic cancer.
        Gastroenterology. 2013; 144: 1252-1261
        • Cortés P.
        • Raimondo M.
        • Wallace M.B.
        • et al.
        The role of endoscopic ultrasound and magnetic resonance cholangiopancreatography in the diagnosis of idiopathic recurrent acute pancreatitis: a narrative review.
        Dig Med Res. 2021; 4: 1-11
        • Tenner S.
        • Baillie J.
        • DeWitt J.
        • et al.
        American College of Gastroenterology guideline: management of acute pancreatitis.
        Am J Gastroenterol. 2013; 108: 1400-1416
        • Working Group IAP/APA Acute Pancreatitis Guidelines
        IAP/APA evidence-based guidelines for the management of acute pancreatitis.
        Pancreatology. 2013; 13: e1-e15
        • Govil A.
        • Agrawal M.K.
        • Agrawal D.
        • et al.
        Role of endoscopic ultrasonography in patients with first episode of idiopathic acute pancreatitis.
        Indian J Gastroenterol. 2014; 33: 241-248
        • Umans D.S.
        • Hallensleben N.D.
        • Verdonk R.C.
        • et al.
        Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis.
        Br J Surg. 2020; 107: 191-199
        • Umans D.S.
        • Rangkuti C.K.
        • Sperna Weiland C.J.
        • et al.
        Endoscopic ultrasonography can detect a cause in the majority of patients with idiopathic acute pancreatitis: a systematic review and meta-analysis.
        Endoscopy. 2020; 52: 955-964
        • Chari S.T.
        Diagnosis of autoimmune pancreatitis using its five cardinal features: introducing the Mayo Clinic's HISORt criteria.
        J Gastroenterol. 2007; 42: 39-41
        • Johnston D.E.
        • Kaplan M.M.
        Pathogenesis and treatment of gallstones.
        N Engl J Med. 1993; 328: 412-421
        • Pinte L.
        • Balaban D.V.
        • Băicuş C.
        • et al.
        Non-alcoholic fatty pancreas disease—practices for clinicians.
        Rom J Intern Med. 2019; 57: 209-219
        • Kirkegård J.
        • Mortensen F.V.
        • Heide-Jørgensen U.
        • et al.
        Predictors of underlying pancreatic cancer in patients with acute pancreatitis: a Danish nationwide cohort study.
        HPB (Oxford). 2020; 22: 553-562
        • Ros E.
        • Navarro S.
        • Bru C.
        • et al.
        Occult microlithiasis in “idiopathic” acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy.
        Gastroenterology. 1991; 101: 1701-1709
        • Guilmanova A.
        • Sikorskaya E.
        • Marino D.
        • et al.
        A simple method for determining the etiology and treatment of idiopathic acute pancreatitis.
        Am J Gastroenterol. 2011; 106: S54
        • Hallensleben N.D.
        • Umans D.S.
        • Bouwense S.A.
        • et al.
        The diagnostic work-up and outcomes of “presumed” idiopathic acute pancreatitis: a post-hoc analysis of a multicentre observational cohort.
        United Eur Gastroenterol J. 2020; 8: 340-350
        • Alempijevic T.
        • Dragasevic S.
        • Zec S.
        • et al.
        Non-alcoholic fatty pancreas disease.
        Postgrad Med J. 2017; 93: 226-230
        • Petrov M.S.
        • Taylor R.
        Intra-pancreatic fat deposition: bringing hidden fat to the fore.
        Nat Rev Gastroenterol Hepatol. 2022; 19: 153-168
        • Acharya C.
        • Navina S.
        • Singh V.P.
        Role of pancreatic fat in the outcomes of pancreatitis.
        Pancreatology. 2014; 14: 403-408
        • Vege S.S.
        • Gardner T.B.
        • Chari S.T.
        • et al.
        Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include "moderately severe acute pancreatitis.
        Am J Gastroenterol. 2009; 104: 710-715
        • Navina S.
        • Acharya C.
        • DeLany J.P.
        • et al.
        Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity.
        Sci Transl Med. 2011; 3: 107-110
        • Della Corte C.
        • Mosca A.
        • Majo F.
        • et al.
        Nonalcoholic fatty pancreas disease and nonalcoholic fatty liver disease: more than ectopic fat.
        Clin Endocrinol. 2015; 83: 656-662
        • Frossard J.L.
        • Lescuyer P.
        • Pastor C.M.
        Experimental evidence of obesity as a risk factor for severe acute pancreatitis.
        World J Gastroenterol. 2009; 15: 5260-5265
        • Zyromski N.J.
        • Mathur A.
        • Pitt H.A.
        • et al.
        A murine model of obesity implicates the adipokine milieu in the pathogenesis of severe acute pancreatitis.
        Am J Physiol Gastrointest Liver Physiol. 2008; 295: G552-G558
        • Sbeit W.
        • Khoury T.
        Fatty pancreas represents a risk factor for acute pancreatitis: a pilot study.
        Pancreas. 2021; 50: 990-993
        • Wallace M.B.
        • Hawes R.H.
        • Durkalski V.
        • et al.
        The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers.
        Gastrointest Endosc. 2001; 53: 294-299
        • Wiersema M.J.
        • Hawes R.H.
        • Lehman G.A.
        • et al.
        Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin.
        Endoscopy. 1993; 25: 555-564
        • Umans D.S.
        • Timmerhuis H.C.
        • Hallensleben N.D.
        • et al.
        Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study.
        BMJ Open. 2020; 10e035504