Intra-abdominal pressure: Time ripe to revise management guidelines of acute pancreatitis?

Table 2 Comparison of Atlanta, revised Atlanta and determinant based classification system of acute pancreatitis

	Atlanta[7]	Revised atlanta[27]	Determinant based system[28]
Mild	Minimal organ dysfunction and an uneventful recovery; lacks the features of severe acute pancreatitis. Usually normal enhancement of pancreatic parenchyma on contrast-enhanced computed tomography	No organ failure	No (peri)pancreatic necrosis and no organ failure2
		No local or systemic complications
Moderate		Organ failure2 that resolves within 48 h (transient organ failure) and/or local or systemic complications without persistent organ failure	Sterile (peri)pancreatic necrosis and/or transient organ failure (< 48 h)2
Severe	Associated with organ failure1 and/or local complications such as acute fluid collections, necrosis, abscess or pseudocyst	Persistent organ failure2 (> 48 h)	Infected (peri)pancreatic necrosis or persistent organ failure (> 48 h)2
		Single organ failure
		Multiple organ failure
Critical			Infected (peri)pancreatic necrosis and persistent organ failure (> 48 h)2

¹Organ failure and systemic complications defined as - Shock (Systolic blood pressure < 90 mmHg), Pulmonary insufficiency (PaO₂≤ 60 mmHg), Renal failure (Creatinine ≥ 177 μmol/L or ≤ 2 mg/dL after rehydration), Gastrointestinal bleeding (500 mL in 24 h), Disseminated intravascular coagulation (Platelets ≤ 100000/mm, fibrinogen < 1.0 g/L and fibrin-split products > 80 μg/L), and Severe metabolic disturbances (Calcium ≤ 1.87 mmol/L or ≤ 7.5 mg/dL);

²Organ failure defined by modified Marshall scoring (Table 3)[29].