Jin Tao, Huang Wei, Yang Xiao-Nan, Xue Ping, Javed Muhammad A, Altaf Kiran, Sutton Robert, Xia Qing
Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Hepatobiliary Pancreat Dis Int. 2014 Jun;13(3):323-7. doi: 10.1016/s1499-3872(14)60255-1.
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.
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.
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% vs 27.1%, P=0.001), and shorter hospital stay (15+/-5 vs 27+/-12 days; 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 but 7 patients died in the severe/critical group (4 for severe group).
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.
近期的国际多学科会诊提议在急性胰腺炎的分层中使用局部因素（无菌性或感染性胰腺坏死）和/或全身因素（器官衰竭）。本研究旨在通过国际多学科会诊定义来验证中度严重程度类别。
92例连续的重症急性胰腺炎患者（根据1992年亚特兰大分类法）被分为：（i）中度急性胰腺炎组，存在无菌性（胰周）胰腺坏死和/或短暂性器官衰竭；（ii）重度/危重症急性胰腺炎组，存在无菌性或感染性胰腺坏死和/或持续性器官衰竭。比较两组的人口统计学和临床结局。
与重度/危重症组（n = 59）相比，中度组（n = 33）的临床和计算机断层扫描评分较低（均P < 0.05）。他们的胰腺坏死发生率也较低（45.5% 对71.2%，P = 0.015）、感染发生率较低（9.1% 对37.3%，P = 0.004）、入住重症监护病房（ICU）的比例较低（0% 对27.1%，P = 0.001），住院时间较短（15 ± 5天对27 ± 12天；P < 0.001）。亚组分析显示，与重度组（n = 51）相比，中度组的ICU入住率也显著较低、住院时间较短且感染率较低。中度组无患者死亡，但重度/危重症组有7例患者死亡（重度组4例）。
我们的数据表明，国际多学科会诊所建议的中度急性胰腺炎定义，即无菌性（胰周）胰腺坏死和/或短暂性器官衰竭，是急性胰腺炎的一个准确类别。
