The Atlanta 2012 versus the Determinant-Based Classifications for Acute Pancreatitis: Which One is Better

Acute pancreatitis (AP) remains a challenging disease by its various etiologies, multiple clinical aspects and unpredicted evolution. The first major contribution to standardize AP was the 1992 Atlanta Classification  but, since then, new information and research emerged as an attempt to eliminate some confusion, to improve severity assessment and to facilitate scientific communications between physicians and different institutions. This improved knowledge led to new classifications: Atlanta 2012 and Determinant Based Classification (DBC).

 Both of them make a distinction between the morphological aspect of AP (fluid collection, pancreatic necrosis, etc.) and the systemic impact of AP (transient/permanent organ failure) and they grade AP severity according to these aspects. Thus, Atlanta 2012 and DBC are not entirely alike and, in specific cases, this could lead to different results. If we can take, for example, a patient with AP and peripancreatic fluid collection without necrosis or organ failure, they can be categorized as Severe Acute Pancreatitis (Atlanta 1992), Moderately-Severe Acute Pancreatitis (Atlanta 2012) or Mild Acute Pancreatitis (DBC), which can be really confusing when two clinicians are talking to each other or report their scientific data. Both these two classifications were presented at the end of 2012 and, since then; a new series of articles was published in an attempt to decide which one is more accurate and more useful for clinical use. But the balance does not favor either yet. One thing is certain: that both these classifications are better than Atlanta 1992 with regard to outcome measures. The aim of the current research is to compare Atlanta 2012 Classification with Determinant Based Classification in terms of clinical applicability and accuracy.

Materials and Methods                                                       

We performed retrospective analysis of all consecutive cases of Acute Pancreatitis admitted into the General Surgery Department of our tertiary, university-affiliated emergency center during a period of 12 months (August 2014 to July 2015). We defined patients with AP according to Atlanta 2012 (two out of three criteria): abdominal pain suggestive of AP, serum lipase or amylase activity at least three times greater than the upper limit and characteristic findings on contrasted enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) or transabdominal ultrasonography (US). The patients were divided into severity groups according to Atlanta 2012 and the Determinant-Based Classification. The main outcomes that we used for evaluation were hospital length of stay, intensive care unit (ICU) admission, ICU length of stay (ICU_LOS) and mortality. Organ failure was assessed according to the modified Marshall scoring system for organ dysfunction. Frequencies and percentage were used as categorical variables. Means and standard deviation were applied for continuous variables. For each classification, testing between grades of severity was done by using Fisher’s exact test and Kruskal-Wallis or One-Way ANOVA as appropriate. To evaluate for normality of distribution we used the Kolmogorov-Smirnov test.