OBJECTIVES: Atlanta classification (Atlanta 1992) of acute pancreatitis (AP) has several limitations. Two new classification systems were recently proposed: the Atlanta reclassification (Atlanta 2012) and the determinant-based classification (DBC). The aim of our study was to: (i) determine the association between different severity categories and clinical outcomes and (ii) perform a head-to-head comparison between Atlanta 1992, Atlanta 2012, and DBC in predicting these clinical outcomes. METHODS: A total of 256 prospectively enrolled patients were assigned a severity category for all three classifications. Five clinical outcomes were evaluated: mortality, intensive care unit (ICU) admission and length of stay (LOS), need for interventions, and hospital LOS. Pairwise testing between severity grades within a classification system was performed using Fisher's exact and Kruskal-Wallis tests. Predictive accuracies were evaluated using area under the ROC curve (AUC) and Somer's D co-efficient. RESULTS: Overall, higher grades of severity were associated with worse clinical outcomes for all three classification systems. Atlanta 2012 and DBC performed better than Atlanta 1992 and were comparable in predicting mortality (AUC 0.89 for both vs. 0.76, P<0.001), ICU admission (AUC 0.91 for both vs. 0.80, P<0.001), and ICU LOS (Somer's D 0.21 and 0.28 vs. 0.07, P<0.05). DBC performed better in predicting need for interventions (AUC 0.93 vs. 0.85, P<0.001), whereas Atlanta 2012 performed better in predicting hospital LOS (Somer's D 0.43 vs. 0.37, P=0.04). CONCLUSIONS: Atlanta 2012 and DBC severity categories accurately reflected clinical outcomes in our cohort and were superior to Atlanta 1992. These novel classification systems can guide the selection of homogeneous patient populations for clinical research and provide an accurate spectrum of disease severity categories in the clinical setting.
OBJECTIVES: Atlanta classification (Atlanta 1992) of acute pancreatitis (AP) has several limitations. Two new classification systems were recently proposed: the Atlanta reclassification (Atlanta 2012) and the determinant-based classification (DBC). The aim of our study was to: (i) determine the association between different severity categories and clinical outcomes and (ii) perform a head-to-head comparison between Atlanta 1992, Atlanta 2012, and DBC in predicting these clinical outcomes. METHODS: A total of 256 prospectively enrolled patients were assigned a severity category for all three classifications. Five clinical outcomes were evaluated: mortality, intensive care unit (ICU) admission and length of stay (LOS), need for interventions, and hospital LOS. Pairwise testing between severity grades within a classification system was performed using Fisher's exact and Kruskal-Wallis tests. Predictive accuracies were evaluated using area under the ROC curve (AUC) and Somer's D co-efficient. RESULTS: Overall, higher grades of severity were associated with worse clinical outcomes for all three classification systems. Atlanta 2012 and DBC performed better than Atlanta 1992 and were comparable in predicting mortality (AUC 0.89 for both vs. 0.76, P<0.001), ICU admission (AUC 0.91 for both vs. 0.80, P<0.001), and ICU LOS (Somer's D 0.21 and 0.28 vs. 0.07, P<0.05). DBC performed better in predicting need for interventions (AUC 0.93 vs. 0.85, P<0.001), whereas Atlanta 2012 performed better in predicting hospital LOS (Somer's D 0.43 vs. 0.37, P=0.04). CONCLUSIONS: Atlanta 2012 and DBC severity categories accurately reflected clinical outcomes in our cohort and were superior to Atlanta 1992. These novel classification systems can guide the selection of homogeneous patient populations for clinical research and provide an accurate spectrum of disease severity categories in the clinical setting.
Authors: Amir Gougol; Jorge D Machicado; Bassem Matta; Pedram Paragomi; Ioannis Pothoulakis; Adam Slivka; David C Whitcomb; Dhiraj Yadav; Georgios I Papachristou Journal: Pancreas Date: 2019 Nov/Dec Impact factor: 3.327
Authors: Haq Nawaz; Efstratios Koutroumpakis; Jeffrey Easler; Adam Slivka; David C Whitcomb; Vijay P Singh; Dhiraj Yadav; Georgios I Papachristou Journal: Am J Gastroenterol Date: 2015-09-01 Impact factor: 10.864
Authors: Efstratios Koutroumpakis; Anil K Dasyam; Alessandro Furlan; Adam Slivka; Amir Gougol; Herbert J Zeh; Kenneth K Lee; Amer H Zureikat; David C Whitcomb; Dhiraj Yadav; Georgios I Papachristou Journal: J Clin Gastroenterol Date: 2016-08 Impact factor: 3.062
Authors: Efstratios Koutroumpakis; Bechien U Wu; Olaf J Bakker; Anwar Dudekula; Vikesh K Singh; Marc G Besselink; Dhiraj Yadav; Rawad Mounzer; Hjalmar C van Santvoort; David C Whitcomb; Hein G Gooszen; Peter A Banks; Georgios I Papachristou Journal: Am J Gastroenterol Date: 2015-11-10 Impact factor: 10.864