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Ann Surg. 2012 Dec;256(6):875-80. doi: 10.1097/SLA.0b013e318256f778.

Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation.

Collaborators (208)

Abu Hilal M, Abu-Zidan FM, Acosta JM, Ainsworth AP, Aizcorbe Garralda M, Alagozlu H, Al'aref SJ, Albeniz Arbizu E, Alhajeri A, Almeida IC, Almeida JL, Amano H, Ammori BJ, Andersson B, Andersson R, Andrén-Sandberg A, Ardengh JC, Arroyo-Sanchez AS, Arvanitakis M, Ashley SW, Aygencel G, Ayoub WA, Baillie J, Bala M, Ball CG, Baron TH, Barreto SG, Basaranoglu M, Beger HG, Bernal Monterde V, Bharwani N, Bhasin DK, Bong JJ, Botoi G, Bruennler T, Cairoli E, Carter CR, Cernea D, Chari ST, Charnley RM, Chooklin S, Cochior D, Conwell DL, Correia MI, Dambrauskas Z, Darvas K, De Campos T, De Casasola GG, De Waele JJ, del Chiaro M, Delle Fave G, Dellinger EP, de-Madaria E, di Sebastiano P, Diuzheva TG, Duarte-Rojo A, Fagenholz PJ, Farre Viladrich A, Fernandez-del Castillo C, Forsmark CE, Friess H, Frossard JL, Gandhi V, Gardner TB, Gloor B, Gluk M, Goltsov VR, Guevara-Campos J, Gumbs AA, Hackert T, Hauser G, Horvath KD, Howard TJ, Igarashi H, Ioannidis O, Jaber S, James FE, Jha RK, Juneja D, Kamisawa T, Kandasami P, Kantarcioglu M, Kapoor VK, Karakan T, Kaya E, Khaliq A, Kiriyama S, Kochhar R, Konstantinou GN, Kylänpää ML, Lankisch PG, Laplaza Santos C, Lata J, Layer P, Leppäniemi A, Levy P, Lopez A, López Camps V, Lujano-Nicolas LA, Lund H, Lytras D, Macaya Redin L, Machado MC, Macias Rodriquez MA, Mann O, Maravi-Poma E, Marincas M, Marwah S, Mas E, Matheus AS, Meier R, Mennecier D, Mentula P, Mifkovic A, Mofidi R, Mole DJ, Morris-Stiff G, Mossner J, Muftuoglu MA, Munsell MA, Nathens AB, Neri V, Nöjgaard C, Nordback I, Ocampo C, Oláh A, Olejnik J, O'Reilly DA, Oria A, Panek J, Papachristou GI, Parekh D, Passaglia C, Pearce CB, Pellegrini D, Perez-Mateo M, Petrov MS, Pettila V, Pezzilli R, Pitchumoni CS, Pongrasobchai S, Poves Prim I, Puolakkainen P, Pupelis G, Radenkovic DV, Rahman SH, Reigdor Sanz E, Repiso A, Rodrigo L, Rosseland A, Rydzewska G, Sánchez-Izuierdo Riera JA, Savides TJ, Scaglione M, Serrablo A, Servin-Torres E, Sethu I, Sezgin O, Shankar-Hari M, Shimosegawa T, Singer MV, Sinha SK, Siriwardena AK, Sjoberg Bexelius T, Skipworth JR, Soriano FG, Sotoudehmanesh R, Spanier BW, Stabuc B, Steinberg W, Stroescu C, Szentkereszty Z, Takacs T, Takada T, Takeda K, Takeyama Y, Tang W, Tanjoh K, Tarnasky PR, Teich N, Tellado JM, Tenner S, Thomson A, Tireli M, Tong Z, Triantopoulou C, Uomo G, Uy MC, van Genen EJ, Velasco Guardado A, Vettoretto N, Vollmer CM Jr, Wada K, Warshaw AL, Weinbroum AA, Whitcomb DC, Wilson JS, Windsor JA, Wittau M, Wu BU, Wysocki AP, Yan Quiroz E, Yasuda T, Yu C, Zerem E, Zhou X, Zubia Olazcoaga F, Zyromski NJ.

Author information

  • 1Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.

Abstract

OBJECTIVE:

To develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation.

BACKGROUND:

The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity.

METHODS:

A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions.

RESULT:

The new international classification is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical.

CONCLUSIONS:

This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.

Comment in

PMID:
22735715
[PubMed - indexed for MEDLINE]
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