Professor Julia Mayerle and colleagues from LMU University Hospital Munich have developed an admission-based score intended to identify pancreatitis patients more likely to be diagnosed with thrombosis during hospitalization. In a cohort of 647 adults, thromboembolic events were common and associated with longer hospital stays, more complications, and higher mortality. The score is an early-detection aid, not a diagnostic test or a guide to anticoagulation.
Key messages
- Among 647 patients, 114 (17.6%) had at least one thromboembolic event diagnosed during hospitalization.
- A six-parameter score separated patients into low-, intermediate-, and high-risk groups with observed event rates of 7.6%, 22.0%, and 38.5%.
- The model showed moderate discrimination but was assessed only in the cohort used to develop it; prospective external validation is required.
Why thrombosis matters in pancreatitis
Pancreatitis can promote clotting through inflammation, endothelial injury, immobility, and local tissue damage. Attention often focuses on clots in abdominal vessels, but deep vein thrombosis and pulmonary embolism can also occur. Existing tools such as BISAP, APACHE II, and Ranson scores assess pancreatitis severity rather than thrombosis risk at admission.
Evidence for screening and treatment remains limited. Symptoms may overlap with pancreatitis itself, and imaging practices vary. The study therefore examined both abdominal and extra-abdominal thromboembolic events and asked whether information available at admission could identify patients at higher risk of having thrombosis detected during the same hospital stay.
What the researchers did
The investigators retrospectively analyzed patients who had been prospectively enrolled in an institutional database between January 2018 and June 2023. The cohort included 365 patients with acute pancreatitis and 282 with chronic pancreatitis. The primary outcome was any diagnosed deep vein thrombosis, pulmonary embolism, portal vein thrombosis, or other splanchnic vein thrombosis during hospitalization. Categories could overlap within one patient.
For score development, the researchers excluded patients with active malignancy and those already receiving full-dose anticoagulation for pre-existing thromboembolic disease. Complete data were available for 409 patients, including 61 with an event. The final 0-8-point score assigned two points each for diastolic blood pressure below 64 mmHg and oxygen saturation below 94%. It assigned one point each for age above 58 years, pulse above 87 beats per minute, systolic blood pressure above 183 mmHg, and body mass index of 27 kg/m2 or lower.
What the study found
Event rates were similar in acute and chronic pancreatitis: 16.2% and 19.5%, respectively. Across the full cohort, deep vein thrombosis occurred in 5.9% and pulmonary embolism in 4.2%. Patients with thromboembolic events had a mortality rate of 8.8% (10 of 114), compared with 2.1% (11 of 533) among those without events. In acute pancreatitis, median hospital stay was 15 days with thrombosis and seven days without it. Severe acute pancreatitis was associated with higher odds of thrombosis than mild disease (odds ratio 3.85, 95% confidence interval 1.57-9.20).
The point score produced an area under the receiver operating characteristic curve of 0.709 using data-derived thresholds. A version using clinically selected thresholds had an area of 0.683; the difference was not statistically significant. These values indicate moderate separation between patients with and without detected thrombosis, not diagnostic certainty.
Meaning, limitations, and next steps
Because the study was observational, it cannot establish whether thrombosis caused poorer outcomes or mainly marked more severe illness. Imaging was not standardized, so some events may have been missed. The single-center score also had no internal resampling or independent external validation, meaning its reported performance may be optimistic.
Future multicenter studies should test calibration, diagnostic yield, unnecessary imaging, and clinical net benefit. Prospective trials are also needed to determine whether score-triggered vascular imaging leads to earlier diagnosis and better outcomes without excess testing or bleeding from subsequent treatment.
See the articles
Vielhauer J, Hausdorf A, Vornhuelz MG, et al. A clinical risk score for early thrombosis detection in acute and chronic pancreatitis: insights from a large cohort study. eGastroenterology 2026;4:e100439. doi:10.1136/egastro-2026-100439
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