Update of the Atlanta Classification of severity of acute pancreatitis: should a moderate category be included?
Pancreatology 2010;
10:613-9. [PMID:
21042037 DOI:
10.1159/000308795]
[Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 03/13/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND
Persistent and multiple organ failure (POF and MOF) are predictive of death in acute pancreatitis (AP). Local complications without organ failure are associated with morbidity but a low risk of mortality.
AIM
To design a three-category classification of AP severity and to compare it with the Atlanta Classification (AC) in terms of morbidity and mortality.
METHOD
Severe AP was defined as death, POF (>48 h) or MOF. Moderate AP was defined as the presence of acute collections and/or pancreatic necrosis. Mild AP was defined by exclusion. We compared this classification with AC in 144 episodes of AP.
RESULTS
In the three-category classification, severe AP was associated with significantly more frequent intensive care unit admission, invasive treatment and mortality than moderate and mild AP (p < 0.01). Severe AP patients required longer hospital stay and more nutritional support than mild AP patients (p < 0.01). Patients with moderate AP had significantly longer hospital stay and more need for nutritional support than patients with mild AP (p < 0.01). Five patients died, all of them with MOF and/or POF.
CONCLUSIONS
A three-category classification distinguishes three homogeneous groups of severity.
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