A comparison between the revision of Atlanta classification and determinant-based classification in acute pancreatitis
10.3760/cma.j.issn.0578-1426.2017.12.004
- VernacularTitle:急性胰腺炎修正亚特兰大分类和基于决定因素分类的比较研究
- Author:
Dong WU
1
;
Bo LU
;
Huadan XUE
;
Yamin LAI
;
Jiaming QIAN
;
Hong YANG
Author Information
1. 100730,中国医学科学院北京协和医学院北京协和医院消化科
- Keywords:
Acute pancreatitis;
Severe acute pancreatitis;
Critical acute pancreatitis;
Revision of Atlanta classification;
Determinant-based classification;
Infected necrosis
- From:
Chinese Journal of Internal Medicine
2017;56(12):909-913
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the performance of the revision of Atlanta classification (RAC) and determinant-based classification (DBC) in acute pancreatitis. Methods Consecutive patients with acute pancreatitis admitted to a single center from January 2001 to January 2015 were retrospectively analyzed. Patients were classified into mild, moderately severe and severe categories based on RAC and were simultaneously classified into mild, moderate, severe and critical grades according to DBC. Disease severity and clinical outcomes were compared between subgroups. The receiver operating curve (ROC) was used to compare the utility of RAC and DBC by calculating the area under curve (AUC). Results Among 1120 patients enrolled, organ failure occurred in 343 patients (30.6%) and infected necrosis in 74 patients (6.6%). A total of 63 patients (5.6%) died. Statistically significant difference of disease severity and outcomes was observed between all the subgroups in RAC and DBC (P<0.001). The category of critical acute pancreatitis (with both persistent organ failure and infected necrosis) had the most severe clinical course and the highest mortality (19/31, 61.3%). DBC had a larger AUC (0.73, 95%CI 0.69-0.78) than RAC (0.68, 95%CI 0.65-0.73) in classifying ICU admissions (P=0.031), but both were similar in predicting mortality(P=0.372) and prolonged ICU stay (P=0.266). Conclusions DBC and RAC perform comparably well in categorizing patients with acute pancreatitis regarding disease severity and clinical outcome. DBC is slightly better than RAC in predicting prolonged hospital stay. Persistent organ failure and infected necrosis are risk factors for poor prognosis and presence of both is associated with the most dismal outcome.
