a Department of Gastroenterology , Shanghai Tenth People's Hospital, Tongji University , Shanghai , People's Republic of China.
b Department of Gastroenterology , Tongji Hospital , Tongji University , Shanghai , People's Republic of China.
Curr Med Res Opin. 2018 Jul;34(7):1231-1238. doi: 10.1080/03007995.2017.1389705. Epub 2017 Nov 3.
Since increasing acute pancreatitis (AP) severity is significantly associated with mortality, accurate and rapid determination of severity is crucial for effective clinical management. This study investigated the value of the revised Atlanta classification (RAC) and the determinant-based classification (DBC) systems in stratifying severity of acute pancreatitis.
This retrospective observational cohort study included 480 AP patients. Patient demographics and clinical characteristics were recorded. The primary outcome was mortality, and secondary outcomes were admission to intensive care unit (ICU), duration of ICU stay, and duration of hospital stay.
Based on the RAC classification, there were 295 patients with mild AP (MAP), 146 patients with moderate-to-severe AP (MSAP), and 39 patients with severe AP (SAP). Based on the DBC classification, there were 389 patients with MAP, 41 patients with MSAP, 32 patients with SAP, and 18 patients with critical AP (CAP). ROC curve analysis showed that the DBC system had a significantly higher accuracy at predicting organ failure compared to the RAC system (p < .001). Multivariate regression analysis showed that age and ICU stay were independent risk factors of mortality.
The DBC system had a higher accuracy at predicting organ failure. Age and ICU stay were significantly associated with risk of death in AP patients. A classification of CAP by the DBC system should warrant close attention, and rapid implementation of effective measures to reduce mortality.
由于急性胰腺炎（AP）严重程度的增加与死亡率显著相关，因此准确快速地确定严重程度对于有效的临床管理至关重要。本研究旨在探讨修订亚特兰大分类（RAC）和基于决定因素的分类（DBC）系统在分层急性胰腺炎严重程度中的价值。
本回顾性观察性队列研究纳入了 480 例 AP 患者。记录了患者的人口统计学和临床特征。主要结局是死亡率，次要结局是入住重症监护病房（ICU）、ICU 住院时间和住院时间。
根据 RAC 分类，295 例为轻度 AP（MAP），146 例为中重度 AP（MSAP），39 例为重度 AP（SAP）。根据 DBC 分类，389 例为 MAP，41 例为 MSAP，32 例为 SAP，18 例为危重症 AP（CAP）。ROC 曲线分析显示，DBC 系统预测器官衰竭的准确性明显高于 RAC 系统（p<0.001）。多变量回归分析显示，年龄和 ICU 住院时间是死亡的独立危险因素。
DBC 系统在预测器官衰竭方面具有更高的准确性。年龄和 ICU 住院时间与 AP 患者的死亡风险显著相关。DBC 系统对 CAP 的分类应引起密切关注，并应迅速采取有效措施降低死亡率。
