000			03799nam a22004697a 4500
008			201231s20202020 xxu||||| |||| 00| 0 eng d
022			_a1542-3565
024			_a10.1016/j.cgh.2020.12.008 [doi]
024			_aS1542-3565(20)31665-7 [pii]
040			_aOvid MEDLINE(R)
099			_a33309984
245			_aComorbidities Drive the Majority of Overall Mortality in Low-risk Mucinous Pancreatic Cysts under Surveillance.
245			_aComorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under Surveillance.
251			_aClinical Gastroenterology & Hepatology. 20(3):631-640.e1, 2022 03.
252			_aClin Gastroenterol Hepatol. 20(3):631-640.e1, 2022 03.
252			_zClin Gastroenterol Hepatol. 2020 Dec 10
253			_aClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
260			_c2022
260			_fFY2021
265			_sppublish
266			_d2020-12-31
268			_aClinical Gastroenterology & Hepatology. 2020 Dec 10
520			_aBACKGROUND & AIMS: The Charlson Comorbidity Index (CACI) has been suggested as a tool to determine comorbidity burden and guide management for patients with mucinous pancreatic cysts (Intrapapillary Mucinous Neoplasms and Mucinous Cystic Neoplasms), but has not been studied well among "low-risk" mucinous pancreatic cysts i.e. without worrisome features (WF) and high-risk stigmata (HRS). This study sought to determine the comorbidity burden among surveillance population of low-risk pancreatic cysts and provide their follow-up mortality outcomes.
520			_aCONCLUSION: Through real-time application of CACI to patient outcomes, our analysis supports incorporation of this comorbidity assessment tool in making shared surveillance decisions among low-risk pancreatic cyst population. Copyright (c) 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
520			_aMETHODS: A single center study retrospectively reviewed a prospective pancreatic cyst database and included individuals with low-risk cysts undergoing serial imaging during 2016. Electronic medical records were reviewed to determine their baseline age-adjusted CACI (age-CACI). After 4 years, their progression to WF, disease specific (pancreatic malignancy-related, DSM), extra-pancreatic (EPM), and overall mortalities (OM) were determined using Kaplan-Meir Survival Analysis.
520			_aRESULTS: 502 individuals underwent prospective surveillance. The study included 440 individuals with low-risk suspected or presumed mucinous cysts and excluded 50 and 12 individuals with WF and HRS respectively. Over a median follow-up of 56 months, 12 WF progressions, 2 DSMs, 42 EPMs, and 44 OMs were observed. Baseline age-CACI had good predictive capacity for 4-year EPM (Area-Under Curve: 0.87; p<.0001). The median age-CACI of 4 enabled cohort stratification into Low (age-CACI <4) and High CACI (age-CACI >=4) groups. A significantly higher OM (p<.001) was observed among the High CACI group as compared to the Low CACI group.
546			_aEnglish
650			_a*Pancreatic Cyst
650			_a*Pancreatic Neoplasms
650			_aComorbidity
650			_aHumans
650			_aPancreatic Cyst/ep [Epidemiology]
650			_aPancreatic Neoplasms/ep [Epidemiology]
650			_aProspective Studies
650			_aRetrospective Studies
651			_aMedStar Union Memorial Hospital
657			_aJournal Article
700			_aYousaf, Muhammad N
790			_aAslanian H, Chhoda A, Farrell JJ, Jamidar PA, Kunstman J, Madhani K, Muniraj T, Salem RA, Suarez AL, Yousaf MN
856			_uhttps://dx.doi.org/10.1016/j.cgh.2020.12.008 _zhttps://dx.doi.org/10.1016/j.cgh.2020.12.008
942			_cART _dArticle
999			_c5943 _d5943