title: Validation of the determinant-based classification and revision of the Atlanta classification systems for acute pancreatitis.
abstract: OBJECTIVE
  Two new classification systems for the severity of acute pancreatitis (AP) have been proposed, the determinant-based classification (DBC) and a revision of the Atlanta classification (RAC). Our aim was to validate and compare these classification systems.
  
  
  METHODS
  We analyzed data from adult patients with AP (543 episodes of AP in 459 patients) who were admitted to Hospital General Universitario de Alicante from December 2007 to February 2013. Imaging results were reviewed, and the classification systems were validated and compared in terms of outcomes.
  
  
  RESULTS
  Pancreatic necrosis was present in 66 of the patients (12%), peripancreatic necrosis in 109 (20%), walled-off necrosis in 61 (11%), acute peripancreatic fluid collections in 98 (18%), and pseudocysts in 19 (4%). Transient and persistent organ failures were present in 31 patients (6%) and 21 patients (4%), respectively. Sixteen patients (3%) died. On the basis of the DBC, 386 (71%), 131 (24%), 23 (4%), and 3 (0.6%) patients were determined to have mild, moderate, severe, or critical AP, respectively. On the basis of the RAC, 363 patients (67%), 160 patients (30%), and 20 patients (4%) were determined to have mild, moderately severe, or severe AP, respectively. The different categories of severity for each classification system were associated with statistically significant and clinically relevant differences in length of hospital stay, need for admission to the intensive care unit, nutritional support, invasive treatment, and in-hospital mortality. In comparing similar categories between the classification systems, no significant differences were found.
  
  
  CONCLUSIONS
  The DBC and the RAC accurately classify the severity of AP in subgroups of patients.
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Nelly G
authors: NG
authors: Acevedo-Piedra
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Neftalí
authors: N
authors: Moya-Hoyo
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Mónica
authors: M
authors: Rey-Riveiro
authors: Servicio de Radiología, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Santiago
authors: S
authors: Gil
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Laura
authors: L
authors: Sempere
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Juan
authors: J
authors: Martínez
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain.
authors: Félix
authors: F
authors: Lluís
authors: Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Alicante, Spain.
authors: José
authors: J
authors: Sánchez-Payá
authors: Unidad de Patología Pancreática, Hospital General Universitario de Alicante, Alicante, Spain. Electronic address: madaria@hotmail.com.
authors: Enrique
authors: E
authors: de-Madaria
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D018529:Nutritional Support; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000145:classification*; D012720:Severity of Illness Index
keywords: AP; DBC; ICU; Infection; Inflammation; Management; Pancreas; RAC; acute pancreatitis; determinant-based classification; intensive care unit; revision of the Atlanta classification