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

de-Madaria E.a · Soler-Sala G.a · Lopez-Font I.a · Zapater P.b · Martínez J.a · Gómez-Escolar L.a · Sánchez-Fortún C.a · Sempere L.a · Pérez-López J.a · Lluís F.c · Pérez-Mateo M.a
aUnidad de Gastroenterología, bServicio de Farmacología Clínica, y cServicio de Cirugía General, Hospital General Universitario de Alicante, Alicante, España Pancreatology 2010;10:613–619 (DOI:10.1159/000308795)


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.


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