A. K. Gulla1, Z. Dambrauskas2, Z. Dambrauskas2 1Georgetown University Medical Center,Department Of Surgery,Washington, DC, USA 2Lithuanian University Of Health Sciences,Department Of Surgery,Kaunas, KAUNAS, Lithuania
Introduction:
Acute pancreatitis (AP) is a severe and frequently life-threatening disease, which can lead to pancreatic necrosis, ALI, SIRS and MODS. This study explores whether or not patients categorized as "moderately severe" under Atlanta 2012 criteria should be treated as severe cases according to Atlanta 1992 due to occurrence of MODS, pancreatic necrosis, infectious complications.
Methods:
103 retrospective AP patients chart review who were admitted to Lithuanian Health Sciences University hospital, Department of Surgery (2008-2013). All patients were confirmed to have diagnosis of AP during the first 24 hours since admission (Atlanta classification, 2012). In addition, the severity of pancreatitis was assessed by MODS and APACHEII scale with reevaluation after 48h and 72 h. All patients were categorized into 3 groups based on severity: mild, moderately severe, severe (Atlanta, 2012). Then, "moderately severe" cases were compared to mild and severe cases according to Atlanta 1992 classification. Outcomes and management were reassessed.
Results:
There were 54 (52.4%) males and 49 (47.6%) females enrolled in the analysis. 53.4% of patients had edematous while 46,6 % had necrotic AP. The most common cause of AP was alcohol (42.7%) followed by alimentary (26,2%), biliary (26,2%), idiopathic (4.9%). Using Revised Atlanta Classification (2012) and Atlanta Classification (1992) there were 49 (47,6%) mild vs 56 (54,4%), 27 (26,2%) moderately severe and 27 (26,2 %) vs 47 (45,6%) severe AP cases accordingly; Therefor, there was no statistical significance difference in ICU stay, use of interventional treatment, infected pancreatic necrosis and mortality rates between the “severe” groups (Atlanta 1992 and Revised Atlanta 2012).
However, "moderately severe" group 27 (103) patients (Atlanta, 2012) compared to severe form 27 of AP (Atlanta, 1992) had significantly better outcomes that those of severe form: necrosis -94,3%, sepsis -22,2%, longer ICU stay -24%) FNA (37%), US guided drainage- 14.8%, surgery -22,2%., APACHE II 13,2 ( p=0.002), MODS ( p=0,001).
This data shows that patients categorized as “moderately severe” (Atlanta, 2012) have similar clinical outcomes, mortality rates and need for intervention compared to “mild” and “self-limiting AP ( Atlanta, 1992) (Table 1).
Conclusion:
Patients who met the new criteria of “moderately severe” acute pancreatitis had more self-limited disease course, fewer complications, lower incidence of SIRS, lower MODS and APACHEII scores, no reported deaths and lower rates of interventions. This study shows that the new Atlanta 2012 criteria reduce unnecessary treatments and should result in better patient outcomes.
