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

Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA)

Research output: Contribution to journalArticle

239 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)875-880
Number of pages6
JournalAnnals of Surgery
Volume256
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Pancreatitis
Referral and Consultation
Necrosis
Oceania
South America
North America
Research

Keywords

  • acute pancreatitis
  • classification
  • organ failure
  • pancreatic infectious complications
  • pancreatic necrosis
  • peripancreatic necrosis
  • severity

ASJC Scopus subject areas

  • Surgery

Cite this

Determinant-based classification of acute pancreatitis severity : An international multidisciplinary consultation. / Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA).

In: Annals of Surgery, Vol. 256, No. 6, 01.12.2012, p. 875-880.

Research output: Contribution to journalArticle

Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA) 2012, 'Determinant-based classification of acute pancreatitis severity: An international multidisciplinary consultation', Annals of Surgery, vol. 256, no. 6, pp. 875-880. https://doi.org/10.1097/SLA.0b013e318256f778
Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA). / Determinant-based classification of acute pancreatitis severity : An international multidisciplinary consultation. In: Annals of Surgery. 2012 ; Vol. 256, No. 6. pp. 875-880.
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T1 - Determinant-based classification of acute pancreatitis severity

T2 - An international multidisciplinary consultation

AU - Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA)

AU - Dellinger, E. Patchen

AU - Forsmark, Christopher E.

AU - Layer, Peter

AU - Lévy, Philippe

AU - Maraví-Poma, Enrique

AU - Petrov, Maxim S.

AU - Shimosegawa, Tooru

AU - Siriwardena, Ajith K.

AU - Uomo, Generoso

AU - Whitcomb, David C.

AU - Windsor, John A.

AU - Abu Hilal, M.

AU - Abu-Zidan, F. M.

AU - Acosta, J. M.

AU - Ainsworth, A. P.

AU - Aizcorbe Garralda, M.

AU - Alagozlu, H.

AU - Al’aref, S. J.

AU - Albeniz Arbizu, E.

AU - Alhajeri, A.

AU - Almeida, I. C.

AU - Almeida, J. L.

AU - Amano, H.

AU - Ammori, B. J.

AU - Andersson, B.

AU - Andersson, R.

AU - Andrén-Sandberg, A.

AU - Ardengh, J. C.

AU - Arroyo-Sanchez, A. S.

AU - Arvanitakis, M.

AU - Ashley, S. W.

AU - Aygencel, G.

AU - Ayoub, W. A.

AU - Baillie, J.

AU - Bala, M.

AU - Ball, C. G.

AU - Baron, T. H.

AU - Barreto, S. G.

AU - Basaranoglu, M.

AU - Beger, H. G.

AU - Bernal Monterde, V.

AU - Bharwani, N.

AU - Bhasin, D. K.

AU - Bong, J. J.

AU - Botoi, G.

AU - Bruennler, T.

AU - Cairoli, E.

AU - Carter, C. R.

AU - Howard, Thomas

AU - Zyromski, Nicholas

PY - 2012/12/1

Y1 - 2012/12/1

N2 - 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.

AB - 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.

KW - acute pancreatitis

KW - classification

KW - organ failure

KW - pancreatic infectious complications

KW - pancreatic necrosis

KW - peripancreatic necrosis

KW - severity

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