Validation of Modified Determinant-Based Classification of severity for acute pancreatitis in a tertiary teaching hospital

The relative merits of two recent classifications of acute pancreatitis severity, the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC), have been debated. A Modified DBC (MDBC) was recently proposed in intensive care unit (ICU) patients. By dividing the DBC ‘severe...

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Published in:Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2019-03, Vol.19 (2), p.217-223
Main Authors: Wu, Dong, Lu, Bo, Xue, Hua-dan, Yang, Hong, Qian, Jia-ming, Lee, Peter, Windsor, John Albert
Format: Article
Language:English
Subjects:
Acute necrotizing pancreatitis
Acute pancreatitis
Classification
Endoscopy
Etiology
Failure
Gender
Infected necrosis
Morbidity
Mortality
Organ failure
Pancreatitis
Renal replacement therapy
Severe acute pancreatitis
Ventilators
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Summary:The relative merits of two recent classifications of acute pancreatitis severity, the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC), have been debated. A Modified DBC (MDBC) was recently proposed in intensive care unit (ICU) patients. By dividing the DBC ‘severe’ category into two groups, the MDBC classified non-mild acute pancreatitis into 4 groups rather than 2 in RAC and 3 in DBC. In this study we aim to validate MDBC in both ICU and non-ICU patients and evaluate infected necrosis as a determinant of severity. Prospective data collected on consecutive patients admitted to a tertiary teaching hospital were retrospectively analyzed. Patients were assigned to the categories of severity defined by the DBC, RAC and MDBC. Clinical interventions and outcomes were compared between categories. A total of 1102 patients were enrolled and the overall mortality was 5.7%. When MDBC was applied, the four Groups were significantly different in regard to ICU admission rates (30%, 40%, 69% and 87%) and mortality (2%, 15%, 40% and 57%). Groups 2 and 3 were different in intervention rates and morbidity, providing evidence that IN is an important determinant of severity. This study validates the MDBC proposal to subdivide the DBC ‘severe’ category into two groups for ICU and non-ICU patients in a tertiary hospital.
ISSN:1424-3903
1424-3911
DOI:10.1016/j.pan.2019.01.003