A single-center study of clinical re-evaluation of the new classification of acute pancreatitis

Abstract

Objective To evaluate the clinical values of the new classification of acute pancreatitis.Methods A total of 649 traditional severe acute pancreatitis (SAP) patients,who were admitted to the Changhai Hospital from January 2005 to December 2012,were retrospectively studied.According to the new classification,these patients were divided into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP),and then the Ranson,APACHE Ⅱ,BISAP,MCTSI scores,Marshall scores,incidence of organ failure,clinical treatment,prognosis and mortality in the two groups were compared.Results Among 649 traditional SAP patients,90 patients were diagnosed to have SAP and 559 were diagnosed as MSAP according to the new classification criteria.The sex ratio,age and etiology were not significantly different between the 2 groups.The Ranson,APACHE Ⅱ,BISAP,MCTSI,Marshall scores of MSAP patients were (1.5 ± 1.3),(7.6 ± 4.8),(1.6 ± 0.9),(6.0 ± 1.8),(0.0 ± 0.4),and the corresponding values in SAP groupwere (3.4±1.7),(16.8t5.7),(2.7±0.9),(6.9±2.1),(4.3±2.0),and the difference between the two groups was statistically significant (P＜0.01).Respiratory failure,renal failure,cardiovascular failure,2 organs failure,3 organs failure occurred in 1,1,0,0 and 1 patient,and the corresponding values were 30,23,1,20,11 patients,and the difference between the two groups was statistically significant (P ＜ 0.05).The needs of ICU admission,blood purification,mechanical ventilation,interventional drainage were significantly higher in SAP patients than those in MSAP patients,and the time was much longer than that in MSAP patients,and the surgical management rate was also significantly higher than that in MSAP patients,and the difference between the two groups was statistically significant (P ＜ 0.01).The rates of enteral nutrition in the two groups were not statistically significant.The mortality rate of the SAP patients was 35.6％ (32/90),which was significantly higher than that of MSAP patients (2.0％,11/559).The median hospital length of SAP patients was (36.3 ± 30.2) d,which was significantly longer than (23.0 ±18.8) d of MSAP patients,and the difference between the two groups was statistically significant (P ＜ 0.01).Conclusions The introduction of new classification method can better reflect the severity of disease,more accurately predict prognosis and guide clinical management. Key words: Pancreatitis; Severe acute pancreatitis; Moderate severe acute pancreatitis; International classification of diseases; Retrospective studies; Prognosis