与共识标准相比，修订后的亚特兰大标准更准确地反映了内镜逆行胰胆管造影术后胰腺炎的严重程度。
The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria.
机构信息
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Division of Gastroenterology, University of Southern California, Los Angeles, CA, USA.
出版信息
United European Gastroenterol J. 2019 May;7(4):557-564. doi: 10.1177/2050640619834839. Epub 2019 Feb 27.
BACKGROUND AND OBJECTIVE
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most prevalent complication after ERCP with an incidence of 3.5%. PEP severity is classified according to either the consensus criteria or the revised Atlanta criteria. In this international cohort study we investigated which classification is the strongest predictor of PEP-related mortality.
METHODS
We reviewed 13,384 consecutive ERCPs performed between 2012 and 2017 in eight hospitals. We gathered data on all pancreatitis-related adverse events and compared the predictive capabilities of both classifications. Furthermore, we investigated the correlation between the two classifications and identified reasons underlying length of stay.
RESULTS
The total sample consisted of 387 patients. The revised Atlanta criteria have a higher sensitivity (100 vs. 55%), specificity (98 vs. 72%) and positive predictive value (58 vs. 5%). There is a significant difference ( < 0.001) between the two classifications. In 124 patients (32%), the length of stay was influenced by concomitant diseases.
CONCLUSION
The revised Atlanta classification is superior in predicting mortality and better reflects PEP severity. This has important implications for researchers, clinicians and patients. For the diagnosis of PEP pancreatitis, the consensus criteria remain the golden standard. However, the revised Atlanta criteria are preferable for defining PEP severity.
背景与目的
内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）是 ERCP 术后最常见的并发症，发病率为 3.5%。PEP 的严重程度根据共识标准或修订的亚特兰大标准进行分类。在这项国际队列研究中，我们调查了哪种分类是 PEP 相关死亡率的最强预测因子。
方法
我们回顾了 2012 年至 2017 年间在 8 家医院进行的 13384 例连续 ERCP。我们收集了所有与胰腺炎相关的不良事件数据，并比较了这两种分类的预测能力。此外，我们还研究了两种分类之间的相关性，并确定了住院时间长短的原因。
结果
总样本包括 387 例患者。修订后的亚特兰大标准具有更高的灵敏度（100 对 55%）、特异性（98 对 72%）和阳性预测值（58 对 5%）。两种分类之间存在显著差异（<0.001）。在 124 例患者（32%）中，住院时间受到合并症的影响。
结论
修订后的亚特兰大分类在预测死亡率方面更优，并且更好地反映了 PEP 的严重程度。这对研究人员、临床医生和患者都有重要意义。对于 PEP 胰腺炎的诊断，共识标准仍然是金标准。然而，修订后的亚特兰大标准更适合定义 PEP 的严重程度。
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