Prospective validation of 4-category classification of acute pancreatitis severity

Atlanta classification divides patients with acute pancreatitis (AP) into mild and severe disease. A 4-category severity classification has been proposed based on the presence or absence of local and systemic determinants, giving rise to mild, moderate, severe, or critical AP. The aim of this study was to validate this new 4-category system of severity classification by examining markers of severity and outcome.

Data from 151 consecutive patients with AP from January 2009 to December 2010 [mean age (SD), 41.1 (3.5) years; 101 men] were collected. Management was standardized. Patients were classified as mild [no necrosis or organ failure (OF)], moderate (sterile necrosis or transient OF), severe [infected necrosis (IN) or persistent OF], or critical (IN and persistent OF) AP. Data were compared between groups for severity and outcome.

There were 21 (13.9%) patients with mild, 63 (41.7%) moderate, 59 (39.1%) severe, and 8 (5.3%) critical AP. There was a significant difference between these categories for length of hospital stay, computed tomographic severity index scores, occurrence of bloodstream infections, incidence of IN, requirements for percutaneous catheter drain, numbers of operations, and mortality.

This prospective case series clinically validated the 4-category classification of AP severity.