Comparison of three classification systems for acute pancreatitis

Abstract

Objective To compare the accuracy of three classification systems [determinant-based classification (DBC), Revision of the Atlanta classification (RAC), and Atlanta classification (AC)] to stratify severity of acute pancreatitis (AP), and to analyze the association between different severity categories and clinical outcomes. Methods In this retrospective study, we reviewed the clinical data of 458 patients with AP admitted to our unit from January 2015 to December 2017. AP severity was stratified according to the three classification systems (DBC, RAC, and AC) respectively. The classification accuracy of three classification systems was analyzed. Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification. Multi-factors logistic regression analysis identified the independent risk fators for mortality of AP. Results Among the three classification systems, there were significant differences in the mortality rate, invasive treatment rate, ICU monitoring rate and the average hospitalization time among the three subtypes (P<0.001). The RAC and DBC were comparable,but performed better than AC in predicting mortality (AUC 0.94 and 0.95 vs.0.63, P<0.001), ICU admission (AUC 0.90 and 0.88 vs 0.60, P<0.001). The DBC performed better than the RAC and OAC in predicting the need for intervention (AUC 0.88 vs 0.69 and 0.68, P<0.001). Persistent organ failure (OR=13.131, P=0.003) and infected necrosis(OR=9.424, P=0.014) were independent risk factors for mortality. Conclusion The accuracy of DBC and RAC to stratify the severity of AP was significantly higher than that of AC. The accuracy of DBC in predicting clinical outcome was genarally higher than that of RAC and AC. Infectious necrosis and persistent organ failure were the independent risk fators for mortality. Key words: Acute pancreatitis; Stratify; Organ failure; Infectious necrosis; Atlanta classification