Revised Atlanta classification and determinant-based classification: Which one better at stratifying outcomes of patients with acute pancreatitis?
BACGROUND
Two different severity classifications (revised Atlanta classification [RAC] and determinant-based classification [DBC]) were recently proposed.


METHODS
This was a retrospective analysis of a prospective acute pancreatitis (AP) database. This study aims to compare the ability of three classification systems (RAC, DBC, and original Atlanta classification [OAC]) to stratify outcomes of AP and to determine the association between different severity categories and clinical outcomes.


RESULTS
Overall, as the grade of severity increased, the morbidity and mortality increased accordingly in the three classification systems. The RAC and DBC were comparable, but performed better than OAC in predicting mortality (AUC 0.92 and 0.95 vs. 0.66, p < 0.001), ICU admission (AUC 0.92 and 0.96 vs. 0.68, p < 0.001), ICU LOS (AUC 0.73 and 0.76 vs. 0.50, p < 0.001), and hospital stay (AUC 0.81 and 0.83 vs. 0.70, p < 0.001). The DBC performed better than the RAC and OAC in predicting the need for intervention (AUC 0.87 vs. 0.79 and 0.68, p < 0.05). The mortality rate in patients with critical DBC category was higher than that in those with severe RAC category (42.1% vs. 24.7%; p = 0.008). POF (OR 19.4, p = 0.001) and IN (OR 11.0, p = 0.025) were independent risk factors for mortality.


CONCLUSIONS
In tertiary referral setting, patients in the critical category are at the greatest risk for death and should be managed in an intensive care unit. Although IN itself may be less influential on mortality than POF, IN as well as POF should be considered as the key determinants for severity stratification.
['Choi|Jun-Ho|JH|', 'Kim|Myung-Hwan|MH|', 'Cho|Dong Hui|DH|', 'Oh|Dongwook|D|', 'Lee|Hyun Woo|HW|', 'Song|Tae Jun|TJ|', 'Park|Do Hyun|DH|', 'Lee|Sang Soo|SS|', 'Seo|Dong-Wan|DW|', 'Lee|Sung Koo|SK|']
D000208:Acute Disease D000328:Adult D000368:Aged D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010195:Pancreatitis D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index D016896:Treatment Outcome
Classification Pancreatitis Infection Organ failure