Hanna Sternby1, Federico Bolado2, Héctor J Canaval-Zuleta3, Carlos Marra-López4, Ana I Hernando-Alonso5, Adolfo Del-Val-Antoñana6, Guillermo García-Rayado7, Robin Rivera-Irigoin8, Francisco J Grau-García9, Lluís Oms10, Judith Millastre-Bocos11, Isabel Pascual-Moreno12, David Martínez-Ares13, Juan A Rodríguez-Oballe14, Antonio López-Serrano15, María L Ruiz-Rebollo16, Alejandro Viejo-Almanzor17, Belén González-de-la-Higuera2, Aitor Orive-Calzada4, Ignacio Gómez-Anta18, José Pamies-Guilabert19, Fátima Fernández-Gutiérrez-Del-Álamo20, Isabel Iranzo-González-Cruz9, Mónica E Pérez-Muñante21, María D Esteba22, Ana Pardillos-Tomé11, Pedro Zapater23, Enrique de-Madaria24. 1. Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden. 2. Department of Gastroenterology, Complejo Universitario de Navarra, Pamplona, Spain. 3. Department of Gastroenterology, Hospital Son LLatzer, Palma de Mallorca, Spain. 4. Department of Gastroenterology, Hospital Universitario Araba, Vitoria-Gasteiz, Spain. 5. Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain. 6. Department of Gastroenterology, Hospital Universitari i Politècnic la Fe, Valencia, Spain. 7. Department of Gastroenterology, University Clinic Hospital, Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain. 8. Department of Gastroenterology, Hospital Costa del Sol, Marbella, Spain. 9. Department of Gastroenterology, Hospital Arnau de Vilanova, Valencia, Spain. 10. Department of Surgery, Consorci Sanitari de Terrassa, Barcelona, Spain. 11. Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain. 12. Department of Gastroenterology, Hospital Clínico Universitario, Valencia, Spain. 13. Department of Gastroenterology, Hospital Meixoeiro, Vigo, Spain. 14. Department of Gastroenterology, Hospital Universitario Vírgen Macarena, Seville, Spain. 15. Department of Gastroenterology, Hospital Universitario Doctor Peset, Valencia, Spain. 16. Department of Gastroenterology, Hospital Clínico Universitario, Valladolid, Spain. 17. Department of Gastroenterology, Hospital Puerta del Mar, Cádiz, Spain. 18. Department of Radiology, Hospital Gregorio Marañón, Madrid, Spain. 19. Department of Radiology, Hospital Universitari i Politècnic la Fe, Valencia, Spain. 20. Department of Radiology, Hospital Costa del Sol, Marbella, Spain. 21. Department of Surgery, Consorci Sanitari Terrassa, Barcelona, Spain. 22. Department of Radiology, Consorci Sanitari Terrassa, Barcelona, Spain. 23. Department of Clinical Pharmacology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain. 24. Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.
Abstract
OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
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Authors: Bassem Matta; Amir Gougol; Xiaotian Gao; Nageshwar Reddy; Rupjyoti Talukdar; Rakesh Kochhar; Mahesh Kumar Goenka; Aiste Gulla; Jose A Gonzalez; Vikesh K Singh; Miguel Ferreira; Tyler Stevens; Sorin T Barbu; Haq Nawaz; Silvia C Gutierrez; Narcis O Zarnescu; Gabriele Capurso; Jeffrey Easler; Konstantinos Triantafyllou; Mario Pelaez-Luna; Shyam Thakkar; Carlos Ocampo; Enrique de-Madaria; Gregory A Cote; Bechien U Wu; Pedram Paragomi; Ioannis Pothoulakis; Gong Tang; Georgios I Papachristou Journal: Clin Gastroenterol Hepatol Date: 2019-11-09 Impact factor: 13.576
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