Clinical Study Of The Diagnose And Classification Of Severe Acute Pancreatitis

Background Diagnosis and classification of acute pancreatitis is important fortreatment, the Atlanta classification diagnostic criteria for severe acute pancreatitis istoo broad,it is important to distinguish severe acute pancreatitis and moderate severeacute pancreatitis between it,At home there is no similar clinical research.Objective To investigate the diagnosis and treatment of moderately severe acutepancreatitis mixed with severe acute pancreatitis.Methods Medical records of157consecutive patients admitted with severe acutepancreatitis to the First Affiliated Hospital of Anhui Medical University from January2009to January2012were reviewed.Severe acute pancreatitis was defined according tothe Atlanta classification.The cohort of157severe acute pancreatitis patients werereclassified into severe acute pancreatitis (SAP):presence of persistent (>48hours) organfailure,with or without local complications.moderate severe acutepancreatitis(MSAP):local complications and/or transient (≤48hours) organ failure.length of hospitalization,In-hospital mortality or auto-discharge rating, need for theintensive care unit (ICU) and the length of stay in the ICU, need for organ supportingor interventions were considered as primary outcomes. Results The death were all in patients with organ failure,But there was no mortalityin local complication patients.Compared with patients with transient organ failure,patients with persistent organ failure had a higher death rate (5.7%vs49.0%，P<0.01).Compared with patients with single organ failure, patients with multiple organfailure had a higher death rate (13.1%vs74.0%，P<0.01). Compared with patients withsevere acute pancreatitis according to the Atlanta classification, Mortality of Patientswith SAP were increased (17.8%vs49.0%, P<0.01), more need for ICU care (41.4%vs81.1%, P<0.01),and more need for organ supporting(53.5%vs88.6%, P=0.002).Mortality of Patients with MSAP were decreased (17.8%vs1.9%, P<0.01), less needfor ICU care (41.4%vs21.1%, P=0.001),and less need for organ supporting(53.5%vs35.5%, P=0.007);Length of hospitalization, the length of stay in the ICU and need forinterventions were no different among the3groups.Conclusion The unique category of severe acute pancreatitis according to the Atlantacriteria may include different (and substantial) degrees of severity, which is necessary toidentify a patient group defined as “moderately severe acute pancreatitis”.