Chen Yuhui, Ke Lu, Tong Zhihui, Li Weiqin, Li Jieshou
Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Repubic of China.
Medicine (Baltimore). 2015 Apr;94(13):e638. doi: 10.1097/MD.0000000000000638.
Recently, the determinant-based classification (DBC) and the Atlanta 2012 have been proposed to provide a basis for study and treatment of acute pancreatitis (AP). The present study aimed to evaluate the association between severity and the DBC, the Atlanta 2012 and the Atlanta 1992, in AP. Patients admitted to our center with AP from January 2007 to July 2013 were reviewed retrospectively. Patients were assigned to severity categories for all the 3 classification systems. The primary outcomes include long-term clinical prognosis (mortality and length-of-hospital stay), major complications (intraabdominal hemorrhage, multiple-organ dysfunction, single organ failure [OF], and sepsis) and clinical interventions (surgical drainage, continuous renal replace therapy [CRRT] lasting time, and mechanical ventilation [MV] lasting time). The classification systems were validated and compared in terms of these abovementioned primary outcomes. A total of 395 patients were enrolled in this retrospective study with an overall 8.86% in-hospital mortality. Intraabdominal hemorrhage was present in 27 (6.84%) of the patients, multiple-organ dysfunction in 73(18.48%), single OF in 67 (16.96%), and sepsis in 73(18.48%). For each classification system, different categories regarding severity were associated with statistically different clinical mortality, major complications, and clinical interventions (P < 0.05). However, the Atlanta 2012 and the DBC performed better than the Atlanta 1992, and they were comparable in predicting mortality (area under curve [AUC] 0.899 and 0.955 vs 0.585, P < 0.05); intraabdominal hemorrhage (AUC 0.930 and 0.961 vs 0.583, P < 0.05), multiple-organ dysfunction (AUC 0.858 and 0.881 vs 0.595, P < 0.05), sepsis (AUC 0.826 and 0.879 vs 0.590, P < 0.05), and surgical drainage (AUC 0.900 and 0.847 vs 0.606, P < 0.05). For continuous variables, the Atlanta 2012 and the DBC were also better than the Atlanta 1992, and they were similar in predicting CRRT lasting time (Somer D 0.379 and 0.360 vs 0.210, P < 0.05) and MV lasting time (Somer D 0.344 and 0.336 vs 0.186, P < 0.05). All the 3 classification systems accurately classify the severity of AP. However, the Atlanta 2012 and the DBC performed better than the Atlanta 1992, and they were comparable in predicting long-term clinical prognosis, major complications, and clinical interventions.
最近，基于决定因素的分类法（DBC）和2012年亚特兰大分类标准已被提出，为急性胰腺炎（AP）的研究和治疗提供依据。本研究旨在评估AP严重程度与DBC、2012年亚特兰大分类标准以及1992年亚特兰大分类标准之间的关联。对2007年1月至2013年7月在本中心收治的AP患者进行回顾性分析。将患者按照这3种分类系统划分严重程度类别。主要结局包括长期临床预后（死亡率和住院时间）、主要并发症（腹腔内出血、多器官功能障碍、单器官功能衰竭[OF]和脓毒症）以及临床干预措施（手术引流、持续肾脏替代治疗[CRRT]持续时间和机械通气[MV]持续时间）。根据上述主要结局对分类系统进行验证和比较。本回顾性研究共纳入395例患者，总体住院死亡率为8.86%。27例（6.84%）患者出现腹腔内出血，73例（18.48%）出现多器官功能障碍，67例（16.96%）出现单器官功能衰竭，73例（18.48%）出现脓毒症。对于每种分类系统，不同严重程度类别在临床死亡率、主要并发症和临床干预措施方面存在统计学差异（P<0.05）。然而，2012年亚特兰大分类标准和DBC比1992年亚特兰大分类标准表现更好，在预测死亡率（曲线下面积[AUC]分别为0.899和0.955，对比0.585，P<0.05）、腹腔内出血（AUC分别为0.930和0.961，对比0.583，P<0.05）、多器官功能障碍（AUC分别为0.858和0.881，对比0.595，P<0.05）、脓毒症（AUC分别为0.826和0.879，对比0.590，P<0.05）以及手术引流（AUC分别为0.900和0.847，对比0.606，P<0.05）方面具有可比性。对于连续变量，2012年亚特兰大分类标准和DBC也比1992年亚特兰大分类标准表现更好，在预测CRRT持续时间（索默D值分别为0.379和0.360，对比0.210，P<0.05）和MV持续时间（索默D值分别为0.344和0.336，对比0.186，P<0.05）方面相似。所有这3种分类系统均能准确划分AP的严重程度。然而，2012年亚特兰大分类标准和DBC比1992年亚特兰大分类标准表现更好，在预测长期临床预后、主要并发症和临床干预措施方面具有可比性。
