Published online Sep 21, 2023. doi: 10.3748/wjg.v29.i35.5138
Peer-review started: June 28, 2023
First decision: July 23, 2023
Revised: August 6, 2023
Accepted: August 28, 2023
Article in press: August 28, 2023
Published online: September 21, 2023
About 30% of acute pancreatitis (AP) cases classified as idiopathic actually have a biliary and thus monocausally treatable origin.
To date, there is no predictive score to differentiate between idiopathic and sludge- and microlithiasis-triggered acute biliary pancreatitis. Undiagnosed biliary pancreatitis aetiology poses the risk of overdiagnosis and additional patient burden. AP triggered by small biliary concrements (microlithiasis and sludge) is a particularly challenging diagnosis.
The aim of this study was to develop a machine-learning based prediction score for the presence of microlithiasis and sludge in AP patients. External score validation was performed at two university pancreas centres.
The clinical and laboratory parameters of 218 AP patients were used to calculate a machine-learning based prediction model for the presence of sludge and microlithiasis. Forty-seven patients with endosonographic evidence of sludge and microlithiasis (and no other possible underlying pancreatitis aetiology) were used in the identification cohort and compared with 171 AP patients without endosonographic evidence of sludge and microlithiasis. We trained supervised machine learning classifiers using H2O.ai automatically selecting the best suitable predictor model to predict micro
The score, constructed from a total of 28 simple variables to be collected in the early phase of pancreatitis-associated hospitalisation and validated externally at two university pancreas centres, can predict the presence of biliary sludge and microlithiasis with an accuracy of 0.7607 (95% confidence interval: 0.673-0.8347), positive predictive value of 0.7573, and negative predictive value of 0.7857.
For the first time, we present a machine-learning based prediction score to differentiate between sludge- and micro
Upon prospective validation, the prediction score will aid in decision-making on which patient to subject to endosonography for diagnostic workup at a first episode of pancreatitis specifically to differentiate between sludge/microlithiasis-triggered and idiopathic AP.