Acute pancreatitis – Validation of Revised Atlanta Classification on 159 patients and prognostic factors

Czech version

Authors: Katarína Floreánová ¹; Petr Dítě ²; Bohuslav Kianička ³; Lenka Dovrtělová ⁴; Marie Přecechtělová ¹
Authors‘ workplace: Interní gastroeneterologická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Aleš Hep, CSc. ¹; Akademické centrum gastroenterologie Interní kliniky LF OU a FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc. ²; Gastroenterologické oddělení II. interní kliniky LF MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc. ³; Katedra podpory zdraví Fakulty sportovních studií MU Brno, vedoucí katedry Mgr. Lenka Dovrtělová, Ph. D. ⁴
Published in: Vnitř Lék 2014; 60(7-8): 567-574
Category: Original Contributions

Overview

Introduction:
In the last few years the Atlanta classification of acute pancreatitis (AP) have been revised. However prognostic markers of AP are still being searched for. The aim of this study is to validate the 3 severity cathegories proposed by the revised Atlanta classification. We also tried to reevaluate the association between two laboratory markers (leucocyte count and RDW – red cell distribution width) on admission and prognosis of the patients with AP.

Methods:
159 patients were included into the study. The patients were classified according to revised Atlanta criteria and the subgroups evaluated according to mortality, lenght of hospital stay and need for interventions. Leucocyte count and RDW on admission was evaluated in the patients.

Results:
All the subgroups of patients were associated with significantly relevant differences in mortality, lenght of hospital stay and need for operations on pancreas. Leucocyte count and RDW were identified as significant predictors for severe AP and RDW was also identified as significant predictor for mortality in patients with AP.

Conclusion:
New categories of severity as defined by Revised Atlanta classification are describing well the mortality, lenght of hospital stay and need for interventions in the patients with AP. Leucocyte count and RDW on admission are needed to be confirmed as potential prognostic markers of severity and mortality in AP.

Key words:
acute pancreatitis – Atlanta classification – leucocyte count – mild form – moderately form – prognostic factors – RDW – severe form

Sources

1. Frey CF. Classification of pancreatitis: State-of-the-art, 1986. Pancreas 1986; 1(1): 62–68.

2. Woolsey G. VIII. the diagnosis and treatment of acute pancreatitis. Ann Surg 1903; 38(5): 726–735.

3. Sarner M, Cotton PB. Classification of pancreatitis. Gut 1984; 25(7): 756–759.

4. Dítě P, Novotný I, Jelíšková M et al. Klasifikace akutní pankreatitidy. Gastroenterológia pre prax 2012; 11(2): 82 -84.

5. Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28–30, 1984. Gastroenterology 1985; 89(3): 683–685.

6. Sarles H. Classification and definition of pancreatitis. Marseilles-Rome 1988. Gastroenterol Clin Biol 1989; 13(11): 857–859.

7. Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993; 128(5): 586–590.

8. Talukdar R, Clemens M, Vege SS. Moderately severe acute pancreatitis: Prospective validation of this new subgroup of acute pancreatitis. Pancreas 2012; 41(2): 306–309.

9. Vege SS, Gardner TB, Chari ST et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: A case for revising the Atlanta classification to include “moderately severe acute pancreatitis”. Am J Gastroenterol 2009; 104(3): 710–715.

10. de-Madaria E, Soler-sala G, Lopez-font I et al. Update of the Atlanta classification of severity of acute pancreatitis: Should a moderate category be included? Pancreatology 2010; 10(5): 613–619.

11. Petrov MS, Windsor JA. Classification of the severity of acute pancreatitis: How many categories make sense? Am J Gastroenterol 2010; 105(1): 74–76.

12. Besselink MGH, van Santvoort HC, Bollen TL et al. Describing computed tomography findings in acute necrotizing pancreatitis with the Atlanta classification: An interobserver agreement study. Pancreas 2006; 33(4): 331–335.

13. van Santvoort HC, Bollen TL, Besselink MG et al. Describing peripancreatic collections in severe acute pancreatitis using morphologic terms: An international interobserver agreement study. Pancreatology 2008; 8(6): 593–599.

14. Banks PA, Bollen TL, Dervenis C et al. Classification of acute pancreatitis – 2012: Revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62(1): 102–111.

15. Marshall JC, Cook DJ, Christou NV et al. Multiple organ dysfunction score: A reliable descriptor of a complex clinical outcome. Crit Care Med 1995; 23(10): 1638–1652.

16. Dellinger EP, Forsmark CE, Layer P et al. Determinant-based classification of acute pancreatitis severity: An international multidisciplinary consultation. Ann Surg 2012; 256(6): 875–880.

17. Nawaz H, Mounzer R, Yadav D et al. Revised Atlanta and determinant-based classification: Application in a prospective cohort of acute pancreatitis patients. Am J Gastroenterol 2013; 108(12): 1911–1917.

18. Acevedo-Piedra NG, Moya-Hoyo N, Rey-Riveiro M et al. New classifications of severity of acute pancreatitis: Validation of determinant-based and revision of the Atlanta classification. Pancreatology 2013; 13(4): e2.

19. Thandassery RB, Yadav TD, Dutta U et al. Prospective validation of 4-category classification of acute pancreatitis severity. Pancreas 2013; 42(3): 392–396.

20. Talukdar R, Bhattacharyya A, Rao B, et al. Validation of the revised Atlanta definitions of severity of acute pancreatitis: Have all loose ends being tied? Pancreatology 2013; 13(4): S6–S7.

21. He WH, Lu NH, Chen YX et al. Analysis of the severity of 932 patients with acute pancreatitis accordance with the revised Atlanta classification. J Gastroenterol Hepatol 2013; 28(4): 679–680.

22. Schütte K, Malfertheiner P. Markers for predicting severity and progression of acute pancreatitis. Best Pract Res Clin Gastroenterol 2008; 22(1): 75–90.

23. Wu BU. Prognosis in acute pancreatitis. CMAJ 2011; 183(6): 673–677.

24. Al Mofleh IA. Severe acute pancreatitis: pathogenetic aspects and prognostic factors. World J Gastroenterol 2008; 14(5): 675–684.

25. Bota S, Sporea I, Sirli R et al. Predictive factors for severe evolution in acute pancreatitis and a new score for predicting a severe outcome. Ann Gastroenterol 2013; 26(2): 156–162.

26. Oskarsson V, Mehrabi M, Orsini N et al. Validation of the harmless acute pancreatitis score in predicting nonsevere course of acute pancreatitis. Pancreatology 2011; 11(5): 464–468.

27. Bartosch-Härlid A, Andersson B, Aho U et al. Artificial neural networks in pancreatic disease. Br J Surg. 2008; 95(7): 817–826.

28. Gress TM, El-Omar E. Revision of the Atlanta classification of acute pancreatitis: The editorial perspective. Gut 2013; 62(1): 1.

29. Lerch MM. Classifying an unpredictable disease: The revised Atlanta classification of acute pancreatitis. Gut 2013; 62(1): 2–3.

30. Lata J, Juránková J, Stibůrek O et al. Probiotika u akutní pankreatitidy – randomizovaná, placebem kontrolovaná, dvojitě slepá studie. Vnitř Lék 2010; 56(2): 111–114.

31. Besselink MG, van Santvoort HC, Boermeester MA et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009; 96(3): 267–273.

32. Lytras D, Manes K, Triantopoulou C et al. Persistent early organ failure: Defining the high-risk group of patients with severe acute pancreatitis? Pancreas 2008; 36(3): 249–254.

33. Bradley EL. Atlanta redux: Revisiting the severity stratification system for acute pancreatitis. Ann Surg 2012; 256(6): 881–882.

34. Blum T, Maisonneuve P, Lowenfels AB et al. Fatal outcome in acute pancreatitis: Its occurrence and early prediction. Pancreatology 2001; 1(3): 237–241.

35. Brisinda G, Maria G, Ferrante A et al. Evaluation of prognostic factors in patients with acute pancreatitis. Hepatogastroenterology 1999; 46(27): 1990–1997.

36. Azab B, Chainani V, Shah N et al. Neutrophil-lymphocyte ratio as a predictor of major adverse cardiac events among diabetic population: A 4-year follow-up study. Angiology 2013; 64(6): 456–465.

37. Armengol-Carrasco M, Oller B, Escudero LE et al. Specific prognostic factors for secondary pancreatic infection in severe acute pancreatitis. Dig Surg 1999; 16(2): 125–129.

38. Dambrauskas Z, Gulbinas A, Pundzius J et al. Value of routine clinical tests in predicting the development of infected pancreatic necrosis in severe acute pancreatitis. Scand J Gastroenterol 2007; 42(10): 1256–1264.

39. Means TR. Free and Easy? Red Cell Distribution Width (RDW) and Prognosis in Cardiac Disease. J Card Fail 2011; 17(4): 299–300.

40. Allen LA, Felker GM, Mehra MR et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 2010; 16(3): 230–238.

41. Förhécz Z, Gombos T, Borgulya G et al. Red cell distribution width in heart failure: Prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009; 158(4): 659–666.

42. Kim J, Kim K, Lee JH et al. Red blood cell distribution width as an independent predictor of all-cause mortality in out of hospital cardiac arrest. Resuscitation 2012; 83(10): 1248–1252.

43. Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009; 277(1–2): 103–108.

44. Cavusoglu E, Chopra V, Gupta A et al. Relation between red blood cell distribution width (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol 2010; 141(2): 141–146.

45. Senol K, Saylam B, Kocaay F et al. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med 2013; 31(4): 687–689.