Determinants of Severity in Acute Pancreatitis
Por:
Sternby H, Bolado F, Canaval-Zuleta HJ, Marra-López C, Hernando-Alonso AI, Del-Val-Antoñana A, García-Rayado G, Rivera-Irigoin R, Grau-García FJ, Oms L, Millastre-Bocos J, Pascual-Moreno I, Martínez-Ares D, Rodríguez-Oballe JA, López-Serrano A, Ruiz-Rebollo ML, Viejo-Almanzor A, González-de-la-Higuera B, Orive-Calzada A, Gómez-Anta I, Pamies-Guilabert J, Fernández-Gutiérrez-Del-Álamo F, Iranzo-González-Cruz I, Pérez-Muñante ME, Esteba MD, Pardillos-Tomé A, Zapater P and De madaria E
Publicada:
1 ago 2019
Ahead of Print:
18 abr 2018
Categoría:
Surgery
Resumen:
Objective: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes.
Summary of Background Data: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease.
Methods: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity.
Results: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality.
Conclusion: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
Filiaciones:
Sternby H:
Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
Bolado F:
Department of Gastroenterology, Complejo Universitario de Navarra, Pamplona, Spain
Canaval-Zuleta HJ:
Department of Gastroenterology, Hospital Son LLatzer, Palma de Mallorca, Spain
Marra-López C:
Department of Gastroenterology, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
Hernando-Alonso AI:
Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain
Del-Val-Antoñana A:
Department of Gastroenterology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
García-Rayado G:
Department of Gastroenterology, University Clinic Hospital, Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
Rivera-Irigoin R:
Department of Gastroenterology, Hospital Costa del Sol, Marbella, Spain
:
Department of Gastroenterology, Hospital Arnau de Vilanova, Valencia, Spain
Oms L:
Department of Surgery, Consorci Sanitari de Terrassa, Barcelona, Spain
Millastre-Bocos J:
Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
Pascual-Moreno I:
Department of Gastroenterology, Hospital Clínico Universitario, Valencia, Spain
Martínez-Ares D:
Department of Gastroenterology, Hospital Meixoeiro, Vigo, Spain
Rodríguez-Oballe JA:
Department of Gastroenterology, Hospital Universitario Vírgen Macarena, Seville, Spain
:
Department of Gastroenterology, Hospital Universitario Doctor Peset, Valencia, Spain
Ruiz-Rebollo ML:
Department of Gastroenterology, Hospital Clínico Universitario, Valladolid, Spain
Viejo-Almanzor A:
Department of Gastroenterology, Hospital Puerta del Mar, Cádiz, Spain
González-de-la-Higuera B:
Department of Gastroenterology, Complejo Universitario de Navarra, Pamplona, Spain
Orive-Calzada A:
Department of Gastroenterology, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
Gómez-Anta I:
Department of Radiology, Hospital Gregorio Marañón, Madrid, Spain
Pamies-Guilabert J:
Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain
Fernández-Gutiérrez-Del-Álamo F:
Department of Radiology, Hospital Costa del Sol, Marbella, Spain
:
Department of Gastroenterology, Hospital Arnau de Vilanova, Valencia, Spain
Pérez-Muñante ME:
Department of Surgery, Consorci Sanitari Terrassa, Barcelona, Spain
Esteba MD:
Department of Radiology, Consorci Sanitari Terrassa, Barcelona, Spain
Pardillos-Tomé A:
Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
Zapater P:
Department of Clinical Pharmacology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
De madaria E:
Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
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