TY - JOUR
T1 - The atlanta classification, revised atlanta classification, and determinant-based classification of acute pancreatitis which is best at stratifying outcomes?
AU - Kadiyala, Vivek
AU - Suleiman, Shadeah L.
AU - McNabb-Baltar, Julia
AU - Wu, Bechien U.
AU - Banks, Peter A.
AU - Singh, Vikesh K.
PY - 2016/3/4
Y1 - 2016/3/4
N2 - Objectives: To determine which classification is more accurate in stratifying severity. Methods: The study used a retrospective analysis of a prospective acute pancreatitis database (June 2005-December 2007). Acute pancreatitis severity was stratified according to the Atlanta classification (AC) 1992, the revised Atlanta classification (RAC) 2012, and the determinant-based classification (DBC) 2012. Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification. Logistic regression identified predictors of mortality. Results: 338 patients were analyzed: 13% had persistent organ failure (POF) (>48 hours), of whom37%hadmultisystem POF, and 11% had pancreatic necrosis, of whom 19% had infected necrosis. Mortality was 4.1%. For predicting mortality (area under the curve), the RAC (0.91) and DBC (0.92) were comparable (P = 0.404); both outperformed the AC (0.81) (P < 0.001). For intensive care unit admission, the RAC (0.85) and DBC (0.85) were comparable (P = 0.949); both outperformed the AC (0.79) (P < 0.05). There were 2 patients in the critical category of the DBC. Multisystem POF was an independent predictor of mortality (odds ratio, 75.0; 95% confidence interval, 13.7-410.6; P < 0.001), whereas single-system POF, sterile necrosis, and infected necrosis were not. Conclusion: 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.
AB - Objectives: To determine which classification is more accurate in stratifying severity. Methods: The study used a retrospective analysis of a prospective acute pancreatitis database (June 2005-December 2007). Acute pancreatitis severity was stratified according to the Atlanta classification (AC) 1992, the revised Atlanta classification (RAC) 2012, and the determinant-based classification (DBC) 2012. Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification. Logistic regression identified predictors of mortality. Results: 338 patients were analyzed: 13% had persistent organ failure (POF) (>48 hours), of whom37%hadmultisystem POF, and 11% had pancreatic necrosis, of whom 19% had infected necrosis. Mortality was 4.1%. For predicting mortality (area under the curve), the RAC (0.91) and DBC (0.92) were comparable (P = 0.404); both outperformed the AC (0.81) (P < 0.001). For intensive care unit admission, the RAC (0.85) and DBC (0.85) were comparable (P = 0.949); both outperformed the AC (0.79) (P < 0.05). There were 2 patients in the critical category of the DBC. Multisystem POF was an independent predictor of mortality (odds ratio, 75.0; 95% confidence interval, 13.7-410.6; P < 0.001), whereas single-system POF, sterile necrosis, and infected necrosis were not. Conclusion: 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.
KW - Acute pancreatitis
KW - Atlanta classification
KW - Determinant-based classification
KW - Mortality
KW - Multisystem persistent organ failure
KW - Revised Atlanta classification
UR - http://www.scopus.com/inward/record.url?scp=84944384994&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84944384994&partnerID=8YFLogxK
U2 - 10.1097/MPA.0000000000000477
DO - 10.1097/MPA.0000000000000477
M3 - Article
C2 - 26474431
AN - SCOPUS:84944384994
SN - 0885-3177
VL - 45
SP - 510
EP - 515
JO - Pancreas
JF - Pancreas
IS - 4
ER -