Published online Nov 21, 2017. doi: 10.3748/wjg.v23.i43.7785
Peer-review started: September 4, 2017
First decision: September 20, 2017
Revised: October 1, 2017
Accepted: November 1, 2017
Article in press: November 1, 2017
Published online: November 21, 2017
The 1992 Atlanta Classifications identified two categories of acute pancreatitis (AP), “mild” and “severe”. However, a subgroup of AP patients who fell in-between the two 1992 severity categories were often observed to have relatively good outcomes and respond positively to less aggressive treatment protocols than those with severe disease. In 2012 the Atlanta classification of AP was revised by adding a third category defined as “moderately severe”.
To the best of authors’ knowledge, there are no studies have evaluated the outcomes and clinical course of “moderately severe” pancreatitis to test their true value in clinical setting. There are no studies have focused on complications, mortality and outcomes of patients with moderately severe AP. The question if the recommended aggressive treatment and expensive interventions are necessary in moderately severe category patients is raises.
The main objectives of this study were to explore the outcomes and the appropriate treatment for patients with moderately severe AP. These objectives were achieved and to the best of our knowledge, no studies have evaluated the outcomes and clinical course of “moderately severe” pancreatitis to test their true value in clinical setting.
The study is based on the data from specially designed database. Since 2008 data of patients with AP, admitted to the Department of Surgery, Hospital of Lithuanian University of Health Sciences were prospectively collected and entered into this database. Statistical analysis was performed on data of 103 AP patients. After stratifying patients into different categories, severe AP groups according to Atlanta 1992 and Atlanta 2012 were compared with each other. Moderately severe (Atlanta 2012) cases were compared to mild and severe cases according to Atlanta 1992 classification and the outcomes and management were re-assessed in all groups.
Both classifications (Atlanta 1992, Atlanta 2012) are accurate for predicting “severe” group of the patients. They both are essentially equivalent in predicting mortality, need for ICU stay and surgical interventional procedure for “severe” AP group. The study also demonstrates that all patients with persistent organ failure do not have the same risk of mortality and should be further stratified. Findings suggest that “moderately severe” AP has a clinical course similar to “mild AP” and often is self-limited or if the treatment is initiated they have less complications and they rarely need intervention (drainage, surgical, etc.).
The revised (2012) Atlanta classification proved to be superior to the former classic (1992) Atlanta classification. Use of the classification system in this way will result in significant costs savings with improved outcomes of the patients.
Similar validation studies could be performed with larger patient cohorts in multicenter setting. The focus of such studies in the future should be on “severe” group of AP patients as the patients of this group require the most intensive treatment and the mortality rate is high.