Validation of the moderate severity category of acute pancreatitis defined by determinant-based classification

摘要： BACKGROUND: Recent international multidisciplinary consultation proposed the use of local(sterile or infected pancreatic necrosis) and/or systemic determinants(organ failure) in the stratification of acute pancreatitis. The present study was to validate the moderate severity category by international multidisciplinary consultation definitions.METHODS: Ninety-two consecutive patients with severe acute pancreatitis(according to the 1992 Atlanta classification) were classified into(i) moderate acute pancreatitis group with the presence of sterile(peri-) pancreatic necrosis and/or transient organ failure; and(ii) severe/critical acute pancreatitis group with the presence of sterile or infected pancreatic necrosis and/or persistent organ failure. Demographic and clinical outcomes were compared between the two groups.RESULTS: Compared with the severe/critical group(n=59), the moderate group(n=33) had lower clinical and computerized tomographic scores(both P<0.05). They also had a lower incidence of pancreatic necrosis(45.5% vs 71.2%, P=0.015),infection(9.1% vs 37.3%, P=0.004), ICU admission(0% vs27.1%, P=0.001), and shorter hospital stay(15±5 vs 27±12days; P<0.001). A subgroup analysis showed that the moderate group also had significantly lower ICU admission rates, shorter hospital stay and lower rate of infection compared with the severe group(n=51). No patients died in the moderate group but7 patients died in the severe/critical group(4 for severe group).CONCLUSIONS: Our data suggest that the definition of moderate acute pancreatitis, as suggested by the international multidisciplinary consultation as sterile(peri-) pancreatic necrosis and/or transient organ failure, is an accurate category of acute pancreatitis. ... （共5頁）