Determinant-Based Classification of Acute Pancreatitis Severity

Dellinger, E. Patchen; Forsmark, Christopher E.; Layer, Peter; Lévy, Philippe; Maraví-Poma, Enrique; Petrov, Maxim S.; Shimosegawa, Tooru; Siriwardena, Ajith K.; Uomo, Generoso; Whitcomb, David C.; Windsor, John A.

doi:10.1097/sla.0b013e318256f778

Cited by 465 publications

(297 citation statements)

References 73 publications

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“…Recently, two severity classifi cation systems were presented: the Revised Atlanta Classifi cation and the Determinant-Based Classifi cation. Both systems underscore the importance of pancreatic necrosis and/or persistent organ failure as determinants of severe AP ( 4,6 ).…”

mentioning

confidence: 99%

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

133

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mentioning

confidence: 99%

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

133

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“…The unanimous opinion is that surgical intervention is mandatory in certain pancreatic infection, otherwise the progression is fatal (4,5). The diagnosis of certainty of infected necrosis is represented only by the positive bacterial or fungal cultures of CT-FNA-guided aspiration in the suspected necrosis area.…”

Section: Discussionmentioning

confidence: 99%

“…The revised classification (Bologna) identifies two evolutionary phases of acute pancreatitis corresponding to two peaks of mortality (4,5): the early phase (the first 7-14 days with systemic inflammatory response syndrome (SIRS) and early MODS / MSOF) and the late phase (2-6 weeks of evolution, with anti-inflammatory compensatory syndrome (CARS), intestinal bacterial translocation, infected pancreatic and peripancreatic collections, tardive MODS / MSOF).…”

Section: Introductionmentioning

confidence: 99%

“…The first phase is characterized by the presence or absence of organ dysfunction (systemic determinants) and very little local peripancreatic changes (local determinants). Therefore, we can say that it is characterized by "functional" or "clinical" aspects that lead to conservative therapeutic behavior (4). Unlike the first, the second phase is characterized by the symptomatology determined mainly by the evolution of local complications at the pancreatic / peripancreatic level, which can also manifest itself systemically through bacteremia and sepsis.…”

Section: Introductionmentioning

confidence: 99%

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Severe Acute Pancreatitis - Determinant Factors and Current Therapeutic Conduct

Constantinoiu¹,

Cochior²

2018

chr

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RezumatAşa cum a fost considerată de Dieulafoy şi cum a rămas, pe drept cuvânt "marea drama abdominală", pancreatita acută a constituit întotdeauna, rămânând ca atare şi în prezent, o adevărată provocare diagnostică şi terapeutică din cauza variabilităţii sale etiologice, clinice şi biologice, caracterului imprevizibil al evoluţiei şi dificultăţilor de stabilire a tratamentului adecvat fiecărui pacient. În acest context s-au confruntat de-a lungul timpului concepţii diferite, uneori diametral opuse, cu privire la interpretarea cazurilor şi la algoritmul terapeutic adoptat, dovadă stând numărul foarte mare de lucrări consacrate acestui subiect. Înţelegerea mai aprofundată a fiziopatologiei pancreatitei acute odată cu creşterea interesului în clasificarea severităţii pe baza factorilor determinanţi (locali şi generali) reprezintă factori decisivi în preconizarea severităţii şi adoptarea strategiei terapeutice moderne a acestei maladii complexe şi heterogene.Cuvinte cheie: pancreatita acută severă, factori determinanţi, disfuncţie multiplă de organe (MODS), necroză închistată (WONwalled of necrosis), necrozectomie, tehnici chirurgicale hibride Abstract Considered by Dieulafoy as the "great abdominal drama", acute pancreatitis has always been, and still remains, a real diagnostic and therapeutic challenge because of its etiological, clinical and biological variability, the unpredictable evolution and the difficulty of establishing appropriate treatment for each patient. In this context, various, sometimes diametrically opposed, conceptions about the interpretation of the cases and the adopted therapeutic algorithm have been encountered over time, as evidenced by the great number of papers dedicated to this subject. A more thorough understanding of acute pancreatitis pathophysiology, with increasing interest in severity classification based on determinant factors (local and general) are decisive factors in predicting severity and adopting the modern therapeutic strategy of this complex and heterogeneous disease.

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“…Recently, two classification systems have been developed for patients with AP to predict mortality risk: the revised Atlanta classification (RAC)9 and the determinant‐based classification (DBC)10. These two systems are useful to characterize case mix and to compare the effectiveness of treatments between centres.…”

Section: Introductionmentioning

confidence: 99%

Relationship between intra-abdominal hypertension, outcome and the revised Atlanta and determinant-based classifications in acute pancreatitis

et al. 2017

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BackgroundThe aim of this study was to analyse the relationship between intra‐abdominal hypertension (IAH) and severity of acute pancreatitis (AP) measured by the revised Atlanta classification (RAC) and determinant‐based classification (DBC). Secondary objectives were to assess IAH as a predictor of morbidity and mortality in the ICU.MethodsThis prospective international observational study included patients admitted to the ICU with AP and at least one organ failure. Information was collected on demographics, severity scores at admission using RAC and DBC, organ failure, mechanical ventilation, continuous renal replacement therapy (CRRT), surgery and mortality. Maximum intra‐abdominal pressure (IAP) during ICU stay was used for analysis.ResultsSome 374 patients were included. The hospital mortality rate was 28·9 per cent. IAP was measured in 301 patients (80·5 per cent), of whom 274 (91·0 per cent) had IAH and 103 (34·2 per cent) acute compartment syndrome. A higher IAH grade was more likely in patients with severe AP (42 per cent for grade I versus 84 per cent for grade IV) and acute critical pancreatitis (9 versus 25 per cent; P = 0·001). Compared with grade I IAH, patients with grade IV had more infected necrosis (16 versus 28 per cent; P = 0·005), need for surgery (27 versus 50 per cent; P = 0·006), mechanical ventilation (53 versus 84 per cent; P = 0·007) and requirement for CRRT (22 versus 66 per cent; P < 0·001). IAH predicted shock (area under receiver operating characteristic (ROC) curve (AUC) 0·79, 95 per cent c.i. 0·73 to 0·84), respiratory failure (AUC 0·82, 0·77 to 0·87), renal failure (AUC 0·93, 0·89 to 0·96) and mortality (AUC 0·89, 0·86 to 0·93).ConclusionIAH was associated with severity of AP classified according to both RAC and DBC systems. IAP grade can predict outcome of AP during ICU stay.

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Determinant-Based Classification of Acute Pancreatitis Severity

Cited by 465 publications

References 73 publications

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Severe Acute Pancreatitis - Determinant Factors and Current Therapeutic Conduct

Relationship between intra-abdominal hypertension, outcome and the revised Atlanta and determinant-based classifications in acute pancreatitis

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