title: Comparison Between Revised Atlanta Classification and Determinant-Based Classification for Acute Pancreatitis in Intensive Care Medicine. Why Do Not Use a Modified Determinant-Based Classification?
abstract: OBJECTIVE
  To compare the classification performance of the Revised Atlanta Classification, the Determinant-Based Classification, and a new modified Determinant-Based Classification according to observed mortality and morbidity.
  
  
  METHODS
  A prospective multicenter observational study conducted in 1-year period.
  
  
  METHODS
  Forty-six international ICUs (Epidemiology of Acute Pancreatitis in Intensive Care Medicine study).
  
  
  METHODS
  Admitted to an ICU with acute pancreatitis and at least one organ failure.
  
  
  METHODS
  Modified Determinant-Based Classification included four categories: In group 1, patients with transient organ failure and without local complications; in group 2, patients with transient organ failure and local complications; in group 3, patients with persistent organ failure and without local complications; and in group 4, patients with persistent organ failure and local complications.
  
  
  RESULTS
  A total of 374 patients were included (mortality rate of 28.9%). When modified Determinant-Based Classification was applied, patients in group 1 presented low mortality (2.26%) and morbidity (5.38%), patients in group 2 presented low mortality (6.67%) and high morbidity (60.71%), patients in group 3 presented high mortality (41.46%) and low morbidity (8.33%), and patients in group 4 presented high mortality (59.09%) and morbidity (88.89%). The area under the receiver operator characteristics curve of modified Determinant-Based Classification for mortality was 0.81 (95% CI, 0.77-0.85), with significant differences in comparison to Revised Atlanta Classification (0.77; 95% CI, 0.73-0.81; p < 0.01), and Determinant-Based Classification (0.77; 95% CI, 0.72-0.81; p < 0.01). For morbidity, the area under the curve of modified Determinant-Based Classification was 0.80 (95% CI, 0.73-0.86), with significant differences in comparison to Revised Atlanta Classification (0.63, 95% CI, 0.57-0.70; p < 0.01), but not in comparison to Determinant-Based Classification (0.81, 95% CI, 0.74-0.88; nonsignificant).
  
  
  CONCLUSIONS
  Modified Determinant-Based Classification identified four groups with different clinical presentation in patients with acute pancreatitis in ICU, with better discriminatory power in comparison to Determinant-Based Classification and Revised Atlanta Classification.
authors.affiliation: 1Intensive Care Department, Donostia University Hospital, Donostia-San Sebastian, Spain. 2Intensive Care Department, Complejo Hospitalario de Navarra, and Medical Talent Sports Program, University of Navarra, Pamplona, Spain. 3Clinical Epidemiology Department, Donostia University Hospital, Donostia-San Sebastian, Spain. 4Intensive Care Department, San Cecilio University Hospital, Granada, Spain. 5Intensive Care Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain. 6Intensive Care Department, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.
authors.forename: Felix
authors.initials: F
authors.lastname: Zubia-Olaskoaga
authors.forename: Enrique
authors.initials: E
authors.lastname: Maraví-Poma
authors.forename: Iratxe
authors.initials: I
authors.lastname: Urreta-Barallobre
authors.forename: María-Rosario
authors.initials: MR
authors.lastname: Ramírez-Puerta
authors.forename: Mónica
authors.initials: M
authors.lastname: Mourelo-Fariña
authors.forename: María-Pilar
authors.initials: MP
authors.lastname: Marcos-Neira
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index