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Z Gastroenterol 2018; 56(12): 1481-1490
DOI: 10.1055/a-0752-0439
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Clinical evaluation of the M-ANNHEIM classification: Development of the M-ANNHEIM-Surgery-Score as a new tool to monitor patients with chronic pancreatitis

Klinische Evaluation der M-ANNHEIM Klassifikation: Entwicklung des M-ANNHEIM-Surgery-Scores als ein neues Instrument zur Überwachung von Patienten mit chronischer Pankreatitis
Michael Hirth
1   Department of Medicine II, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Christel Weiss
2   Medical Statistics, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Felix Rückert
3   Department of Surgery, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Roland H. Pfützer
1   Department of Medicine II, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Torsten J. Wilhelm
3   Department of Surgery, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Svetlana Hetjens
2   Medical Statistics, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Philip D. Hardt
4   Department of Gastroenterology, University-Hospital Gießen, Gießen, Germany
,
Natalia Gubergrits
5   Department of Gastroenterology, University-Hospital Donetsk, Donetsk, Ukraine
,
Matthias P. Ebert
1   Department of Medicine II, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
,
Alexander Schneider
1   Department of Medicine II, University-Medical-Center Mannheim, Medical Faculty at Mannheim, University of Heidelberg, Mannheim, Germany
› Author Affiliations
Further Information

Publication History

29 September 2017

23 September 2018

Publication Date:
10 December 2018 (online)

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Abstract

Objectives The M-ANNHEIM classification of chronic pancreatitis (CP) stratifies degrees of disease severity according to the M-ANNHEIM-Severity-Score. We aimed to demonstrate the clinical usefulness of the M-ANNHEIM-Severity-Score in quantifying and predicting the frequency of pancreatic surgery, and to establish the M-ANNHEIM-Surgery-Score as a simplified system for patient surveillance regarding the demand of pancreatic surgery.

Methods We performed a retrospective, cross-sectional study with 741 CP patients (Mannheim/Germany, n = 537; Gießen/Germany, n = 100; Donetsk/Ukraine, n = 104) categorized according to the M-ANNHEIM classification.

Results We observed a significantly higher M-ANNHEIM-Severity-Score in patients that were classified within 7 days preceding pancreatic surgery than in individuals that did not require surgery (p < 0.001, Mann–Whitney-U-test). Using a logistic regression analysis with all variables of the M-ANNHEIM-Severity-Score, we established the M-ANNHEIM-Surgery-Score as a simplified new tool to identify patients that may require surgery. A receiver operating characteristic-analysis revealed a cut-off-value of 9 points within the M-ANNHEIM-Surgery-Score to identify these individuals (sensitivity 78.7 %, specificity 91 %). Based on the M-ANNHEIM-Surgery-Score, we defined three categories for demand of surgery with frequencies of pancreatic operations of 1.6 % (n = 7/440) in the “Baseline-Demand”-category, 7 % (n = 12/172) in the “Low-Demand”-category (p < 0.0001, Chi-square-test, OR 4.6, Confidence Interval (CI) 1.8 – 12), and 54 % (n = 70/129) in the “High-Demand”-category (p < 0.0001, OR 73, CI 32 – 167). Patients that were categorized for the “High-Demand”-category, but were not operated on, had a significantly increased ratio of clinical features that hamper performance of surgery (p < 0.001, Chi-square-test).

Conclusions The M-ANNHEIM-Surgery-Score represents a useful tool to monitor patients with CP and to estimate the demand of surgery in CP.

Zusammenfassung

Hintergrund und Ziele Die M-ANNHEIM-Klassifikation der chronischen Pankreatitis unterscheidet verschiedene Erkrankungsaktivitäten gemäß dem M-ANNHEIM-Severity-Score. Es war das Ziel unserer Arbeit, den klinischen Nutzen des M-ANNHEIM-Severity-Score bei der Quantifizierung des Bedarfs an Pankreasoperationen und bei der Vorhersage hinsichtlich einer Operationsnotwendigkeit bei Patienten mit chronischer Pankreatitis aufzuzeigen und den M-ANNHEIM-Surgery-Score als ein vereinfachtes System zur Patientenüberwachung hinsichtlich des Operationsbedarfs zu etablieren.

Methoden Wir führten eine retrospektive Querschnittsstudie mit 741 Patienten mit chronischer Pankreatitis durch (Mannheim/Deutschland, n = 537; Gießen/Deutschland, n = 100; Donetsk/Ukraine, n = 104), die gemäß der M-ANNHEIM-Klassifikation kategorisiert waren.

Ergebnisse Wir beobachteten einen signifikant höheren M-ANNHEIM-Severity-Score bei Patienten, die innerhalb von 7 Tagen vor einer Pankreasoperation klassifiziert wurden, als bei Patienten, die nicht unmittelbar vor einer Operation standen (p < 0,001, Mann–Whitney-U-Test). Wir konnten durch eine logistische Regressionsanalyse mit allen Variablen des M-ANNHEIM-Severity-Score den M-ANNHEIM-Surgery-Score als ein vereinfachtes und neues Werkzeug etablieren, das zur Identifikation von Patienten beiträgt, die möglicherweise eine Pankreasoperation benötigen. Eine Receiver-Operator-Characteristic-Analyse ergab einen Cut-Off-Wert von 9 Punkten im M-ANNHEIM-Surgery-Score, der diese Patienten identifiziert (Sensitivität 78,7 %, Spezifität 91 %). Mit dem M-ANNHEIM-Surgery-Score konnten 3 Kategorien des Bedarfs einer Pankreasoperation abgegrenzt werden: Die „Basisbedarfskategorie“ mit einer Häufigkeit von Pankreasoperationen von 1,6 % (n = 7/440), die „Niedrigbedarfskategorie“ mit einer Häufigkeit von Pankreasoperationen von 7 % (n = 12/172; p < 0,0001, Chi-Square-Test, OR 4,6, Konfidenzintervall (CI) 1,8 – 12) und die „Hochbedarfskategorie“ mit einer Häufigkeit von Pankreasoperationen von 54 % (n = 70/129; p < 0,0001, OR 73, CI 32 – 167). Patienten, die in der „Hochbedarfskategorie“ lagen, die aber nicht operiert wurden, hatten signifikant häufiger klinische Merkmale, die die Durchführung einer Pankreasoperation behinderten (p < 0,001, Chi-Square-Test).

Schlussfolgerung Der M-ANNHEIM-Surgery-Score stellt ein nützliches Werkzeug zur Überwachung von Patienten mit chronischer Pankreatitis dar und unterstützt die Einschätzung des Bedarfs einer Pankreasoperation in diesem Patientenkollektiv.

Key words

chronic pancreatitis - classification - pancreatic surgery - pancreatic imaging

Schlüsselwörter

Chronische Pankreatitis - Klassifikation - Pankreasoperation - Pankreasbildgebung
 

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