Determinant-based classification and revision of the Atlanta classification, which one should we choose to categorize acute pancreatitis?

BACKGROUND: Two new systems of acute pancreatitis (AP) severity classification, namely, the determinant-based classification (DBC) and the revision of the Atlanta classification (RAC), were recently published. Information is lacking on the differences between the two systems.

METHODS: We analyzed data from adult patients with AP (973 episodes), admitted to West China Hospital from July 2012 through March 2013. We validated and compared the DBC and RAC systems by investigating the discordances between the RAC and DBC.

RESULTS: Using the RAC system, 66%, 27%, and 7% of the patients were categorized as mild, moderately severe, and severe, respectively. Using the DBC system, 83%, 7%, 7%, and 2% patients were determined to have mild, moderate, severe, and critical AP, respectively. The mortality and ICU admission rates were similar between the subgroups of the severe category under the RAC system. The severe and critical categories had similar mortality rates [35% (7/20) vs. 29% (20/70), P = 0.59] based on DBC. A subgroup of severe category of DBC (IPN and no persistent OF) had significantly lower mortality rate than the other two subgroups of severe category of DBC (SPN and persistent OF; persistent OF and no PN) [0% (0/18) vs. 29% (10/34) vs. 56% (10/18), P < 0.05].

CONCLUSION: Some subgroups of severe categories under the DBC system did not accurately reflected clinical outcomes. RAC seemed to be a better choice to guide the selection of patient populations for clinical research and provide a more accurate description of AP classification in the clinical setting than DBC.