title: [International multidisciplinary classification of acute pancreatitis severity: the 2013 Spanish edition].
abstract: OBJECTIVE
  To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of the published evidence, and worldwide consultation.
  
  
  BACKGROUND
  The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of specialist in pancreatic diseases, but are suboptimal because these definitions are based on the empiric description of events not associated with severity.
  
  
  METHODS
  A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists and radiologists currently active in the field of clinical 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 organized to bring contributors from different disciplines together and discuss the concept and definitions.
  
  
  RESULTS
  The new classification of severity is based on the actual local and systemic determinants of severity, rather than on the description of events that are non-causally associated 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, whereby the presence of both infected (peri) pancreatic necrosis and persistent organ failure has a greater impact upon severity than either determinant alone. The derivation of a classification based on the above principles results in four categories of severity: mild, moderate, severe, and critical.
  
  
  CONCLUSIONS
  This classification is the result of a consultative process among specialists in pancreatic diseases 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: UCI-B, Complejo Hospitalario de Navarra (antiguo Hospital Virgen del Camino), Pamplona, España. Electronic address: enrique.maravi.poma@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Maraví-Poma
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle, Estados Unidos.
authors.forename: E
authors.initials: E
authors.lastname: Patchen Dellinger
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Estados Unidos.
authors.forename: C E
authors.initials: CE
authors.lastname: Forsmark
authors.affiliation: Department of Internal Medicine, Israelitic Hospital, Hamburgo, Alemania.
authors.forename: P
authors.initials: P
authors.lastname: Layer
authors.affiliation: Pôle des Maladies de l'Appareil Digestif, Service de Gastroenterologie-Pancreatologie, Hopital Beaujon, Clichy, Francia.
authors.forename: P
authors.initials: P
authors.lastname: Lévy
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japón.
authors.forename: T
authors.initials: T
authors.lastname: Shimosegawa
authors.affiliation: Department of Surgery, Manchester Royal Infirmary, University of Manchester, Manchester, Reino Unido.
authors.forename: A K
authors.initials: AK
authors.lastname: Siriwardena
authors.affiliation: Department of Internal Medicine, Cardarelli Hospital, Nápoles, Italia.
authors.forename: G
authors.initials: G
authors.lastname: Uomo
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Department of Cell Biology and Molecular Physiology, Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, Estados Unidos.
authors.forename: D C
authors.initials: DC
authors.lastname: Whitcomb
authors.affiliation: Department of Surgery, University of Auckland, Miembro International Association of Pancreatology, Auckland, Nueva Zelanda.
authors.forename: J A
authors.initials: JA
authors.lastname: Windsor
authors.affiliation: Department of Surgery, University of Auckland, Miembro International Association of Pancreatology, Auckland, Nueva Zelanda.
authors.forename: M S
authors.initials: MS
authors.lastname: Petrov
mesh_terms: D000208:Acute Disease; D006801:Humans; D038622:Internationality; D010195:Pancreatitis / Q000145:classification*; D012720:Severity of Illness Index
keywords: (peri) pancreatic necrosis; Acute pancreatitis; Clasificación; Classification; Complicaciones infecciosas pancreáticas; Fracaso orgánico; Gravedad; Necrosis (peri)pancreática; Organ failure; Pancreatic infectious complications; Pancreatitis aguda; Severity