The Atlanta Classification, Revised Atlanta Classification, and Determinant-Based Classification of Acute Pancreatitis

Kadiyala, Vivek; Suleiman, Shadeah; McNabb‐Baltar, Julia; Wu, Bechien U.; Banks, Peter A.; Singh, Vikesh K.

doi:10.1097/mpa.0000000000000477

Cited by 45 publications

(32 citation statements)

References 18 publications

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“…This is in agreement with many prior studies that have indicated that both the RAC and the DBC strongly predict length of hospital stay better than OAC without any significant differences between them [9,10,22]. Further, while little work has been done to assess the predictive capacity of BISAP and PANC 3 on LOS, both systems have been shown to have predictive capacity at identifying severe AP as defined by RAC and DBC [4,17,19]; so it logically follows that their predictive capacity at identifying the length of stay should be similar to RAC and DBC.…”

Section: Discussionsupporting

confidence: 82%

“…Both these 2 systems classify AP after at least 48 h of admission using complications such as organ failure and local complications to determine severity. Both have been shown to be more effective than OAC at stratifying in terms of severity [7][8][9][10]. However, since at least 48 h are required, these systems are more useful for classifying disease severity than predicting it.…”

Section: Introductionmentioning

confidence: 99%

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Maximizing the Use of Scoring Systems in the Prediction of Outcomes in Acute Pancreatitis

et al. 2018

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Background/Aims: No single classification system has so far effectively predicted the severity for Acute Pancreatitis (AP). This study compares the effectiveness of classification systems: Original Atlanta (OAC), Revised Atlanta (RAC), Determinant based classification (DBC), PANC 3, Harmless AP Score (HAPS), Japanese Severity Score (JSS), Symptoms Nutrition Necrosis Antibiotics and Pain (SNNAP), and Beside Index of Severity for AP (BISAP) in predicting outcomes in AP. Methods: Scores for BISAP, Panc 3, HAPS, SNNAP, OAC, RAC, and DBC were calculated for 221 adult patients hospitalized for AP. Receiver Operating Characteristic curve analysis and Akaike Information Criteria were used to compare the effectiveness of predicting need for surgery, intensive care unit (ICU) admission, readmission within 30 days, and length of hospital stay. Results: Both the RAC and the DBC strongly predict the length of hospital stay (p < 0.0001 for both) and ICU admission (p < 0.0001 for both). Additionally, both BISAP and PANC 3 showed weak predictive capacity at identifying length of stay and ICU admission. Conclusions: We suggest that BISAP and PANC3 be obtained within the initial 24 h of hospitalization to offer an early prediction of length of stay and ICU admission. Subsequently, RAC and DBC can offer further information later in the course of the disease.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Maximizing the Use of Scoring Systems in the Prediction of Outcomes in Acute Pancreatitis

et al. 2018

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“…Every patient in our study underwent pancreatic imaging. AP was divided into 3 degrees based on severity: mild, moderately severe, and severe acute pancreatitis, according to the Atlanta Classification 2012 revision [2,11,12]. Patients diagnosed with MAP had an absence of organ failure and local/systemic complications.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Worsening of Acute Pancreatitis in Patients Admitted with Mild Acute Pancreatitis

Jin

Wang

et al. 2017

Med Sci Monit

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BackgroundThe aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP).Material/MethodsPatients admitted with MAP to our hospital from March 2013 to May 2016 were included and prospectively evaluated. Possible risk factors for developing MSAP or SAP were age, blood glucose level on admission, etiology, sex, Ranson score, amylase level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, C-reactive protein (CRP) level, serum calcium level, visceral fat area (VFA), body mass index (BMI), whether this was the first episode of AP, and method of administration of octreotide. The effects of variables for developing MSAP or SAP were evaluated using univariate and multivariate logistic regression models. Mortality, hospital duration, and rate of ICU transfer of patients were compared between patients who developed MSAP or SAP and patients who did not.ResultsA total of 602 patients admitted with MAP were recruited into this study (256 men and 346 women). Seventy-four patients (12.3%) developed MSAP or SAP. According to univariate logistic regression analyses, the results indicated that there were 5 significant differences between patients who developed MSAP or SAP and those who did not: VFA (>100 cm2) (p=0.003), BMI (≥25 kg/m2) (p=0.001), Ranson score(p=0.004), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.040). Further multivariate logistic regression analyses revealed that BMI (≥25 kg/m2) (p=0.005), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.004) were independent risk factors for developing MSAP or SAP in patients admitted with MAP. Moreover, patients who developed MSAP or SAP had a mortality rate of 5.4%.ConclusionsSignificant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m2), APACHE-II (≥5), and blood glucose level on admission (>11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.

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“…[16][17][18] Patients who are transferred to hospitals represent a population of severely ill patients with a higher morbidity and mortality than those who are directly admitted to a hospital. 31,[33][34][35][36] Extrapancreatic Necrosis Overall, the prevalence of persistent organ failure is 4% among patients directly admitted to a hospital compared with 26% to 39% when transferred patients are included in the data.…”

Section: Persistent Organ Failurementioning

confidence: 99%

Acute Pancreatitis

Banks¹

2016

Pancreas

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A great deal of progress has been made in the last 50 years in the diagnosis and treatment of acute pancreatitis. Many landmark studies have been published and have focused on the classification of acute pancreatitis, markers of severity, important roles of imaging and endoscopy, and improvements in our treatment. This report will review several landmark studies, describe ongoing controversies in management decisions including standards of early fluid resuscitation and appropriate use of enteral feeding, and outline what will be required in the future to improve the care of patients with acute pancreatitis.

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The Atlanta Classification, Revised Atlanta Classification, and Determinant-Based Classification of Acute Pancreatitis

Abstract: The RAC and DBC were generally comparable in stratifying severity. The paucity of patients in the critical category in the DBC limits its utility. Neither classification accounts for the impact of multisystem POF, which was the strongest predictor of mortality.

Cited by 45 publications

References 18 publications

Maximizing the Use of Scoring Systems in the Prediction of Outcomes in Acute Pancreatitis

Maximizing the Use of Scoring Systems in the Prediction of Outcomes in Acute Pancreatitis

Risk Factors for Worsening of Acute Pancreatitis in Patients Admitted with Mild Acute Pancreatitis

Acute Pancreatitis

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