Validation of the revised atlanta classification in predicting the severity of acute pancreatitis

Introduction and aim: Determination of acute pancreatitis (AP) severity is crucial for patient management. The aim of our study is to evaluate the validity of the revised Atlanta classification (RAC) to determine AP severity. Material and methods: The study was conducted on AP patients who were admitted to the Gastroenterology Department of Sakarya University Training and Research Hospital between June and December 2015. Patients were retrospectively evaluated for pancreatitis morphology (interstitial edematous and necrotizing), severity (mild, moderate and severe) and local complications according to the RAC. Laboratory parameters, APACHE-II (Acute Physiology and Chronic Health Evaluation-II), Ranson, BISAP (Bedside Index Of Severity In Acute Pancreatitis), SIRS (Systemic Inflammatory Response Syndrome), Modified Glasgow, Panc 3, HAPS (Harmless Acute Pancreatitis Score) and CTSI (Computed Tomography Severity Index) scores were recorded. Results: The study group included 113 patients. The mean age of the patients was 62,2±17,5 (18-94) years. Seventy-one (62%) of them were female. Ninety-eight (86.7%) patients had interstitial edematous and 15 (13.3%) had necrotizing pancreatitis. Sixty-nine (61.1%) patients had mild (MAP), 33 (29.2%) had moderate (MSAP) and 11 (9,7%) had severe pancreatitis (SAP) according to the RAC. Twenty-two (19,5%) patients had acute pancreatic fluid collection, 1 (0,9%) had pancreatic pseudocyst, 6 had (5,3%) acute necrotic collection, 8 had (7,1%) walled-off necrosis and 5 (4,4%) had primary infected necrosis. Hematocrit and creatinine levels; SIRS and BISAP scores on admission; APACHE-II scores at the 24th hour; CRP (C-Reaktive Protein), APACHE-II, modified Glasgow, SIRS and Ranson scores at the 48th hour; CRP levels at the 72nd hour; total hospital stay, need for intensive care unit and mortality were higher in patients with SAP compared to MSAP (p<0,05). SIRS scores on admission, CRP levels at the 72nd hour and Ranson scores were significantly higher in MSAP compared to MAP (p<0,05). Eleven patients had single or multiple persistent viii organ failure (POF). Mortality (83.3%) was higher in patients with early POF (n=6) compared to late POF (40%). Conclusion: RAC is compatible with laboratory parameters and scoring systems in predicting the severity of AP. Patients with severe acute pancreatitis, who develop early POF may be categorized in a different group.