title: Validation of the moderate severity category of acute pancreatitis defined by determinant-based classification.
abstract: BACKGROUND
  Recent international multidisciplinary consultation proposed the use of local (sterile or infected pancreatic necrosis) and/or systemic determinants (organ failure) in the stratification of acute pancreatitis. The present study was to validate the moderate severity category by international multidisciplinary consultation definitions.
  
  
  METHODS
  Ninety-two consecutive patients with severe acute pancreatitis (according to the 1992 Atlanta classification) were classified into (i) moderate acute pancreatitis group with the presence of sterile (peri-) pancreatic necrosis and/or transient organ failure; and (ii) severe/critical acute pancreatitis group with the presence of sterile or infected pancreatic necrosis and/or persistent organ failure. Demographic and clinical outcomes were compared between the two groups.
  
  
  RESULTS
  Compared with the severe/critical group (n=59), the moderate group (n=33) had lower clinical and computerized tomographic scores (both P<0.05). They also had a lower incidence of pancreatic necrosis (45.5% vs 71.2%, P=0.015), infection (9.1% vs 37.3%, P=0.004), ICU admission (0% vs 27.1%, P=0.001), and shorter hospital stay (15+/-5 vs 27+/-12 days; P<0.001). A subgroup analysis showed that the moderate group also had significantly lower ICU admission rates, shorter hospital stay and lower rate of infection compared with the severe group (n=51). No patients died in the moderate group but 7 patients died in the severe/critical group (4 for severe group).
  
  
  CONCLUSIONS
  Our data suggest that the definition of moderate acute pancreatitis, as suggested by the international multidisciplinary consultation as sterile (peri-) pancreatic necrosis and/or transient organ failure, is an accurate category of acute pancreatitis.
authors.affiliation: Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center, West China Hospital, Sichuan University, Chengdu 610041, China. xiaqing@medmail.com.cn.
authors.forename: Tao
authors.initials: T
authors.lastname: Jin
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Xiao-Nan
authors.initials: XN
authors.lastname: Yang
authors.forename: Ping
authors.initials: P
authors.lastname: Xue
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Javed
authors.forename: Kiran
authors.initials: K
authors.lastname: Altaf
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: Qing
authors.initials: Q
authors.lastname: Xia
mesh_terms: D018806:APACHE; D000328:Adult; D015415:Biomarkers / Q000097:blood; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010195:Pancreatitis / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D019283:Pancreatitis, Acute Necrotizing / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers