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Validation of the moderate severity category of acute pancreatitis defined by determinant-based classification
Tao Jin1, Wei Huang, Xiao-Nan Yang
1Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center, West China Hospital, Sichuan University, Chengdu 610041, China. xiaqing@medmail.com.cn.
Background:
Recent international multidisciplinary consultation proposed the use of local (sterile or infected pancreatic necrosis) and/or systemic determinants (organ failure) in the stratification of acute pancreatitis. The present study was to validate the moderate severity category by international multidisciplinary consultation definitions.
Methods:
Ninety-two consecutive patients with severe acute pancreatitis (according to the 1992 Atlanta classification) were classified into (i) moderate acute pancreatitis group with the presence of sterile (peri-) pancreatic necrosis and/or transient organ failure; and (ii) severe/critical acute pancreatitis group with the presence of sterile or infected pancreatic necrosis and/or persistent organ failure. Demographic and clinical outcomes were compared between the two groups.
Results:
Compared with the severe/critical group (n=59), the moderate group (n=33) had lower clinical and computerized tomographic scores (both P<0.05). They also had a lower incidence of pancreatic necrosis (45.5% vs 71.2%, P=0.015), infection (9.1% vs 37.3%, P=0.004), ICU admission (0% vs 27.1%, P=0.001), and shorter hospital stay (15+/-5 vs 27+/-12 days; P<0.001). A subgroup analysis showed that the moderate group also had significantly lower ICU admission rates, shorter hospital stay and lower rate of infection compared with the severe group (n=51). No patients died in the moderate group but 7 patients died in the severe/critical group (4 for severe group).
Conclusions:
Our data suggest that the definition of moderate acute pancreatitis, as suggested by the international multidisciplinary consultation as sterile (peri-) pancreatic necrosis and/or transient organ failure, is an accurate category of acute pancreatitis.
Insights
The international multidisciplinary consultation
Area of Science:
- Gastroenterology and Hepatology
- Surgical Gastroenterology
- Critical Care Medicine
Background:
- International guidelines propose stratifying acute pancreatitis using local (pancreatic necrosis) and systemic (organ failure) factors.
- Validation of the 'moderate' severity category defined by these international guidelines was assessed.
Purpose of the Study:
- To validate the accuracy of the international multidisciplinary consultation's definition for moderate acute pancreatitis.
- To compare clinical outcomes between moderate and severe/critical acute pancreatitis cases.
Main Methods:
- Ninety-two severe acute pancreatitis patients were classified into moderate (sterile necrosis/transient organ failure) or severe/critical (infected necrosis/persistent organ failure) groups.
- Demographic and clinical outcomes were compared between the two groups.
Main Results:
- The moderate group showed significantly lower CT scores, necrosis rates (45.5% vs 71.2%), infection rates (9.1% vs 37.3%), and ICU admissions (0% vs 27.1%).
- Moderate pancreatitis patients experienced shorter hospital stays (15 vs 27 days) and had no mortality, unlike the severe/critical group (7 deaths).
Conclusions:
- The international multidisciplinary consultation's definition of moderate acute pancreatitis (sterile necrosis and/or transient organ failure) is accurate.
- This classification effectively distinguishes a less severe form of acute pancreatitis with better outcomes.
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