Journal Mobile Options
Table of Contents
Vol. 10, No. 5, 2010
Issue release date: December 2010
Pancreatology 2010;10:613–619

Update of the Atlanta Classification of Severity of Acute Pancreatitis: Should a Moderate Category Be Included?

de-Madaria E. · Soler-Sala G. · Lopez-Font I. · Zapater P. · Martínez J. · Gómez-Escolar L. · Sánchez-Fortún C. · Sempere L. · Pérez-López J. · Lluís F. · Pérez-Mateo M.
aUnidad de Gastroenterología, bServicio de Farmacología Clínica, y cServicio de Cirugía General, Hospital General Universitario de Alicante, Alicante, España

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Persistent and multiple organ failure (POF and MOF) are predictive of death in acute pancreatitis (AP). Local complications without organ failure are associated with morbidity but a low risk of mortality. Aim: To design a three-category classification of AP severity and to compare it with the Atlanta Classification (AC) in terms of morbidity and mortality. Method: Severe AP was defined as death, POF (>48 h) or MOF. Moderate AP was defined as the presence of acute collections and/or pancreatic necrosis. Mild AP was defined by exclusion. We compared this classification with AC in 144 episodes of AP. Results: In the three-category classification, severe AP was associated with significantly more frequent intensive care unit admission, invasive treatment and mortality than moderate and mild AP (p < 0.01). Severe AP patients required longer hospital stay and more nutritional support than mild AP patients (p < 0.01). Patients with moderate AP had significantly longer hospital stay and more need for nutritional support than patients with mild AP (p < 0.01). Five patients died, all of them with MOF and/or POF. Conclusions: A three-category classification distinguishes three homogeneous groups of severity.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Lowenfels AB, Maisonneuve P, Sullivan T: The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep 2009;11:97–103.
  2. Lumsden A, Bradley EL III: Secondary pancreatic infections. Surg Gynecol Obstet 1990;170:459–467.
  3. Bradley EL III: A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128:586–590.
  4. Buter A, Imrie CW, Carter CR, Evans S, McKay CJ: Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002;89:298–302.
  5. Johnson CD, Abu-Hilal M: Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;53:1340–1344.
  6. Halonen KI, Pettila V, Leppaniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK: Multiple organ dysfunction associated with severe acute pancreatitis. Crit Care Med 2002;30:1274–1279.
  7. Vege SS, Gardner TB, Chari ST, Munukuti P, Pearson RK, Clain JE, Petersen BT, Baron TH, Farnell MB, Sarr MG: Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta Classification to include ‘moderately severe acute pancreatitis’. Am J Gastroenterol 2009;104:710–715.
  8. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ: Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995;23:1638–1652.
  9. Uomo G: Do we really need a new category of severity for patients with acute pancreatitis? JOP 2009;10:583–584.

    External Resources

  10. Petrov MS, Windsor JA: Classification of the severity of acute pancreatitis: how many categories make sense? Am J Gastroenterol 2010;105:74–76.
  11. Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, Schaapherder AF, Gooszen HG: Timing and impact of infections in acute pancreatitis. Br J Surg 2009;96:267–273.
  12. Lytras D, Manes K, Triantopoulou C, Paraskeva C, Delis S, Avgerinos C, Dervenis C: Persistent early organ failure: defining the high-risk group of patients with severe acute pancreatitis? Pancreas 2008;36:249–254.
  13. Allardyce DB: Incidence of necrotizing pancreatitis and factors related to mortality. Am J Surg 1987;154:295–299.
  14. Tran DD, Cuesta MA, Schneider AJ, Wesdorp RI: Prevalence and prediction of multiple organ system failure and mortality in acute pancreatitis. J Crit Care 1993;8:145–153.
  15. de Beaux AC, Palmer KR, Carter DC: Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 1995;37:121–126.
  16. Isenmann R, Rau B, Beger HG: Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 1999;86:1020–1024.
  17. Perez A, Whang EE, Brooks DC, Moore FD Jr, Hughes MD, Sica GT, Zinner MJ, Ashley SW, Banks PA: Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas 2002;25:229–233.
  18. Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG: Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 2001;1:237–241.
  19. Zhu AJ, Shi JS, Sun XJ: Organ failure associated with severe acute pancreatitis. World J Gastroenterol 2003;9:2570–2573.
  20. Kong L, Santiago N, Han TQ, Zhang SD: Clinical characteristics and prognostic factors of severe acute pancreatitis. World J Gastroenterol 2004;10:3336–3338.

    External Resources

  21. Rau BM, Bothe A, Kron M, Beger HG: Role of early multisystem organ failure as major risk factor for pancreatic infections and death in severe acute pancreatitis. Clin Gastroenterol Hepatol 2006;4:1053–1061.
  22. Fu CY, Yeh CN, Hsu JT, Jan YY, Hwang TL: Timing of mortality in severe acute pancreatitis: experience from 643 patients. World J Gastroenterol 2007;13:1966–1969.
  23. Sharma M, Banerjee D, Garg PK: Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol 2007;102:2688–2695.
  24. Kourtesis G, Wilson SE, Williams RA: The clinical significance of fluid collections in acute pancreatitis. Am Surg 1990;56:796–799.
  25. Maringhini A, Uomo G, Patti R, Rabitti P, Termini A, Cavallera A, Dardanoni G, Manes G, Ciambra M, Laccetti M, Biffarella P, Pagliaro L: Pseudocysts in acute nonalcoholic pancreatitis: incidence and natural history. Dig Dis Sci 1999;44:1669–1673.
  26. Tenner S, Sica G, Hughes M, Noordhoek E, Feng S, Zinner M, Banks PA: Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997;113:899–903.
  27. Lankisch PG, Pflichthofer D, Lehnick D: No strict correlation between necrosis and organ failure in acute pancreatitis. Pancreas 2000;20:319–322.
  28. Company L, Saez J, Martinez J, Aparicio JR, Laveda R, Grino P, Perez-Mateo M: Factors predicting mortality in severe acute pancreatitis. Pancreatology 2003;3:144–148.
  29. Malangoni MA, Martin AS: Outcome of severe acute pancreatitis. Am J Surg 2005;189:273–277.
  30. Ashley SW, Perez A, Pierce EA, Brooks DC, Moore FD, Jr., Whang EE, Banks PA, Zinner MJ: Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases. Ann Surg 2001;234:572–579.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50