Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2017; 23(43): 7785-7790
Published online Nov 21, 2017. doi: 10.3748/wjg.v23.i43.7785
How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification
Povilas Ignatavicius, Aiste Gulla, Karolis Cernauskis, Giedrius Barauskas, Zilvinas Dambrauskas
Povilas Ignatavicius, Karolis Cernauskis, Giedrius Barauskas, Zilvinas Dambrauskas, Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
Aiste Gulla, Department of Surgery, Georgetown University Hospital, Reservoir 3800, Washington, DC 20007, United States
Aiste Gulla, Department of Surgery, Division of Vascular Surgery, Vilnius University, Santariskiu Clinics, Vilnius 08661, Lithuania
Author contributions: Ignatavicius P and Gulla A contributed equally to this work; Ignatavicius P and Gulla A collected and analyzed the data, and drafted the manuscript; Cernauskis K collected and reviewed the data, performed statistical analysis; Dambrauskas Z designed and supervised the study, performed statistical analysis; Barauskas G and Dambrauskas Z revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Kaunas Regional Biomedical Research Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zilvinas Dambrauskas, MD, PhD, Professor, Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Eiveniu st. 2, Kaunas 50009, Lithuania. zilvinas.dambrauskas@lsmuni.lt
Telephone: +370-68669255 Fax: +370-37326179
Received: September 2, 2017
Peer-review started: September 4, 2017
First decision: September 20, 2017
Revised: October 1, 2017
Accepted: November 1, 2017
Article in press: November 1, 2017
Published online: November 21, 2017
Processing time: 78 Days and 11.6 Hours
Abstract
AIM

To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis (AP).

METHODS

Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery, Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE II scale. Clinical course was re-evaluated after 24, 48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild, moderately severe, and severe. Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.

RESULTS

Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol (42.7%) followed by alimentary (26.2%), biliary (26.2%) and idiopathic (4.9%). Under Atlanta 1992 classification 56 (54.4%) cases were classified as “mild” and 47 (45.6%) as “severe”. Using the revised classification (Atlanta 2012), the patient stratification was different: 49 (47.6%) mild, 27 (26.2%) moderately severe and 27 (26.2%) severe AP cases. The two severe groups (Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters, including ICU stay, need for interventional treatment, infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients (according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP (according to Atlanta 1992) with lower incidence of necrosis and sepsis, lower APACHE II (P = 0.002) and MODS (P = 0.001) scores, shorter ICU stay, decreased need for interventional and surgical treatment.

CONCLUSION

Study shows that Atlanta 2012 criteria are more accurate, reduce unnecessary treatments for patients with mild and moderate severe pancreatitis, potentially resulting in health costs savings.

Keywords: Acute pancreatitis; Atlanta 1992; Atlanta 2012; Severity stratification; Treatment; Outcomes

Core tip: The revised (2012) Atlanta classification proved to be superior to the former classic (1992) Atlanta classification. The results of this study support the use of Atlanta 2012 classification in clinical setting and suggest that “moderately” severe AP cases could be treated as “mild” AP once temporary organ failure is controlled, and should result in significant health costs savings without compromising the patient’s outcomes.