title: Acute Pancreatitis Classifications: Basis and Key Goals.
abstract: To explore the efficacy of the revised Atlanta classification (RACAP) and the determinant-based classification of acute pancreatitis severity (DBCAPS) on the basis of clinical data and feedback from patients with acute pancreatitis (AP). The authors retrospectively investigated a total of 573 patients with AP admitted to our hospital between December 2011 and December 2014. The definitions of severity and local complications in AP using RACAP and DBCAPS are presented and common points and mutual differences between the 2 groups are analyzed and discussed. Classification according to RACAP and DBCAPS found 86 (15%) and 178 (31.1%) mild cases (P < 0.01), 269 (46.9%) and 176 (30.7%) moderate cases (P < 0.01), and 218 (38.0%) and 219 (38.2%) severe cases (P = 0.95), respectively. A major contribution of DBCAPS is the introduction of a new type of severe AP, critical AP, identified in 4 patients (0.7%). Complications were observed in 313 RACAP-defined cases and 153 DBCAPS-defined cases (P < 0.01). Among the 313 RACAP-defined cases, acute peripancreatic fluid collection (236 patients, 75.40%), pancreatic pseudocysts (20 patients, 6.4%), acute necrotic collection (42 patients, 13.4%), and walled-off necrosis (15 patients, 4.8%) were observed. Among the 153 DBCAPS-defined cases, sterile peripancreatic necrosis (105 patients, 68.6%), sterile pancreatic necrosis (44 patients, 28.8%), infected peripancreatic necrosis (2 patients, 1.3%), and infected pancreatic necrosis (2/153 patients, 1.3%) were observed. Both classifications adopted organ failure and complications as determinants of severity. Revised Atlanta classification refined local complications and DBCAPS modified severity to include critical AP. In accordance with the demands of precision medicine, a combination of the 2 could be important for further clinical practice and scientific research.
authors.affiliation: From the Department of General Surgery (XDX, ZYW, RN, FXW, WH, HHZ, YWZ, ZGW, XHG, LQG, JZM, YCZ), Hepato-Biliary-Pancreatic Institute (XDX, ZYW, RN, FXW, WH, HHZ, YWZ, ZGW, XHG, LQG, JZM, YCZ), Department of Hepatology, Lanzhou University Second Hospital, Lanzhou, China (LYZ).
authors.forename: Xiao Dong
authors.initials: XD
authors.lastname: Xu
authors.forename: Zhe Yuan
authors.initials: ZY
authors.lastname: Wang
authors.forename: Ling Yi
authors.initials: LY
authors.lastname: Zhang
authors.forename: Rui
authors.initials: R
authors.lastname: Ni
authors.forename: Feng Xian
authors.initials: FX
authors.lastname: Wei
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Hui Han
authors.initials: HH
authors.lastname: Zhang
authors.forename: Ya Wu
authors.initials: YW
authors.lastname: Zhang
authors.forename: Zhen Gang
authors.initials: ZG
authors.lastname: Wei
authors.forename: Xiao Hu
authors.initials: XH
authors.lastname: Guo
authors.forename: Liu Qiang
authors.initials: LQ
authors.lastname: Guo
authors.forename: Jian Zhong
authors.initials: JZ
authors.lastname: Ma
authors.forename: You Cheng
authors.initials: YC
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000145:classification* / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed