title: [Determinant-based classification of acute pancreatitis severity. International multidisciplinary classification of acute pancreatitis severity: the 2013 German edition].
abstract: OBJECTIVE
  The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation.
  
  
  BACKGROUND
  The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric descriptions of occurrences that are merely associated with severity.
  
  
  METHODS
  A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensive medicine specialists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organised to bring contributors from different disciplines together and discuss the concept and definitions.
  
  
  RESULTS
  The new international classification is based on the actual local and systemic determinants of severity, rather than descriptions of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity - mild, moderate, severe, and critical.
  
  
  CONCLUSIONS
  This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.
authors.affiliation: Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland. p.layer@ik-h.de
authors.forename: P
authors.initials: P
authors.lastname: Layer
authors.forename: E P
authors.initials: EP
authors.lastname: Dellinger
authors.forename: C E
authors.initials: CE
authors.lastname: Forsmark
authors.forename: P
authors.initials: P
authors.lastname: Lévy
authors.forename: E
authors.initials: E
authors.lastname: Maraví-Poma
authors.forename: T
authors.initials: T
authors.lastname: Shimosegawa
authors.forename: A K
authors.initials: AK
authors.lastname: Siriwardena
authors.forename: G
authors.initials: G
authors.lastname: Uomo
authors.forename: D C
authors.initials: DC
authors.lastname: Whitcomb
authors.forename: J A
authors.initials: JA
authors.lastname: Windsor
authors.forename: M S
authors.initials: MS
authors.lastname: Petrov
mesh_terms: D005858:Germany; D006801:Humans; D038801:International Classification of Diseases; D038622:Internationality; D010195:Pancreatitis / Q000145:classification* / Q000175:diagnosis*; D012720:Severity of Illness Index