Application Of Different Classification Systems In The Prediction Of Clinical Outcomes In Acute Pancreatitis

Background:Acute pancreatitis(AP)is a potentially lethal disease with complex course.Currently,there are three different classification systems,revision of Atlanta Classification(RAC),Determinant-based Classification(DBC)and Modified-Determinant-based Classification(M-DBC).These classification systems have their own limitations,and whether different classification system can predict the prognosis of patients is still controversial.Objective:The purpose of this article is to compare the performance of RAC,DBC and M-DBC classification in judging the prognosis of AP patients.Methods:Consecutive patients with acute pancreatitis admitted to our department from January 2012 to August 2019 were retrospectively analyzed.Patients were classified base on RAC,DBC and M-DBC classification.Five main clinical outcomes were mortality,intensive care unit(ICU)admission,need for intervention,ICU stay and hospital stay.The receiver operating characteristic curve(ROC)was constructed,area under the curve(AUC)and Spearman's correlation coefficient(Spearman's p)were used to compare the accuracy in predicting main clinical outcomes.Results:A total of 3685 patients were included,with a total mortality rate of 3.3%.When RAC Classification was applied,there were 1789(48.5%),1241(33.7%),and 655(17.8%)patients were categorized as mild,moderately severe and severe AP.When DBC Classification was applied,there were 2547(66.7%),664(18.0%),402(10.9%),and 162(4.4%)patients were categorized as mild,moderate,severe,and critical AP.When M-DBC Classification was applied,1016 patients with organ failure were included,358(35.2%),26(2.5%),and 466(45.9%)patients were categorized as group 1,group 2,group 3,and group 4.For all hospitalized patients,DBC had a larger AUC than RAC in classifying need for intervention(AUC:0.853 vs.0.817,P<0.001).DBC classification perform better than RAC classification in predicting prolonged ICU stay(Spearman's p 0.574 vs.0.534,P<0.05).For ICU hospitalized patients with at least one organ failure,both M-DBC and DBC classification perform better than RAC classification in predicting mortality,need for intervention,prolonged ICU stay and hospital stay,but there is no significant difference between M-DBC and DBC classification.Conclusions:All three classification systems can accurately classify the severity of AP patients.For all hospitalized patients,DBC classification perform comparably better in need for intervention and prolonged ICU stay.For ICU hospitalized patients with at least one organ failure,M-DBC and DBC classification slightly better than RAC in predicting mortality,need for intervention,prolonged ICU stay and hospital stay.