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Comparison Between Revised Atlanta Classification and Determinant-Based Classification for Acute Pancreatitis in
Felix Zubia-Olaskoaga1, Enrique Maraví-Poma, Iratxe Urreta-Barallobre
11Intensive Care Department, Donostia University Hospital, Donostia-San Sebastian, Spain. 2Intensive Care Department, Complejo Hospitalario de Navarra, and Medical Talent Sports Program, University of Navarra, Pamplona, Spain. 3Clinical Epidemiology Department, Donostia University Hospital, Donostia-San Sebastian, Spain. 4Intensive Care Department, San Cecilio University Hospital, Granada, Spain. 5Intensive Care Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain. 6Intensive Care Department, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
Objective:
To compare the classification performance of the Revised Atlanta Classification, the Determinant-Based Classification, and a new modified Determinant-Based Classification according to observed mortality and morbidity.
Design:
A prospective multicenter observational study conducted in 1-year period.
Setting:
Forty-six international ICUs (Epidemiology of Acute Pancreatitis in Intensive Care Medicine study).
Patients:
Admitted to an ICU with acute pancreatitis and at least one organ failure.
Interventions:
Modified Determinant-Based Classification included four categories: In group 1, patients with transient organ failure and without local complications; in group 2, patients with transient organ failure and local complications; in group 3, patients with persistent organ failure and without local complications; and in group 4, patients with persistent organ failure and local complications.
Measurements And Main Results:
A total of 374 patients were included (mortality rate of 28.9%). When modified Determinant-Based Classification was applied, patients in group 1 presented low mortality (2.26%) and morbidity (5.38%), patients in group 2 presented low mortality (6.67%) and high morbidity (60.71%), patients in group 3 presented high mortality (41.46%) and low morbidity (8.33%), and patients in group 4 presented high mortality (59.09%) and morbidity (88.89%). The area under the receiver operator characteristics curve of modified Determinant-Based Classification for mortality was 0.81 (95% CI, 0.77-0.85), with significant differences in comparison to Revised Atlanta Classification (0.77; 95% CI, 0.73-0.81; p < 0.01), and Determinant-Based Classification (0.77; 95% CI, 0.72-0.81; p < 0.01). For morbidity, the area under the curve of modified Determinant-Based Classification was 0.80 (95% CI, 0.73-0.86), with significant differences in comparison to Revised Atlanta Classification (0.63, 95% CI, 0.57-0.70; p < 0.01), but not in comparison to Determinant-Based Classification (0.81, 95% CI, 0.74-0.88; nonsignificant).
Conclusion:
Modified Determinant-Based Classification identified four groups with different clinical presentation in patients with acute pancreatitis in ICU, with better discriminatory power in comparison to Determinant-Based Classification and Revised Atlanta Classification.
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