Layer P, Dellinger E P, Forsmark C E, Lévy P, Maraví-Poma E, Shimosegawa T, Siriwardena A K, Uomo G, Whitcomb D C, Windsor J A, Petrov M S
Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland.
Z Gastroenterol. 2013 Jun;51(6):544-50. doi: 10.1055/s-0033-1335526. Epub 2013 Jun 5.
The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation.
The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric descriptions of occurrences that are merely associated with severity.
A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensive medicine specialists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organised to bring contributors from different disciplines together and discuss the concept and definitions.
The new international classification is based on the actual local and systemic determinants of severity, rather than descriptions of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity - mild, moderate, severe, and critical.
This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.
本研究旨在基于合理的概念框架、对已发表证据的全面回顾以及全球范围内的咨询，制定一种新的急性胰腺炎严重程度国际分类法。
急性胰腺炎严重程度的亚特兰大定义已深深融入胰腺病学家的词汇表中，但并不理想，因为这些定义基于对仅与严重程度相关的事件的经验性描述。
向目前活跃于急性胰腺炎临床研究的所有外科医生、胃肠病学家、内科医生、重症医学专家和放射科医生发出个人邀请，参与新的急性胰腺炎严重程度国际分类法的制定。邀请不限于某些协会的成员或某些国家的居民。开展了一项基于网络的全球调查，并组织了一次专门的国际研讨会，以使来自不同学科的参与者汇聚一堂，讨论该概念和定义。
新的国际分类法基于严重程度的实际局部和全身决定因素，而非与严重程度相关的事件描述。局部决定因素涉及是否存在（胰）胰腺坏死，若存在，是无菌性还是感染性的。全身决定因素涉及是否存在器官功能衰竭，若存在，是短暂性还是持续性的。一个决定因素的存在可改变另一个决定因素的影响，使得感染性（胰）胰腺坏死和持续性器官功能衰竭同时存在对严重程度的影响大于任一决定因素单独存在时的影响。基于上述原则得出的分类法产生了4种严重程度类别——轻度、中度、重度和危重型。
本分类法是来自北美、南美、欧洲、亚洲、大洋洲和非洲49个国家的胰腺病学家协商过程的结果。它提供了一套简洁的最新定义，涵盖了临床实践和研究中与急性胰腺炎严重程度分类相关的所有主要实体。这确保了基于决定因素的分类法能在全球以统一方式使用。
