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A Journal on Internal Medicine
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,236
Minerva Medica 2013 December;104(6):649-57
Multidisciplinar international classification of the severity of acute pancreatitis: italian version 2013
Uomo G. 1, Patchen Dellinger E. 2, Forsmark C. E. 3, Layer P. 4, Lévy P. 5, Maravì-Poma E. 6, Shimosegawa T. 7, Siriwardena A. K. 8, Whitcomb D. C. 9, Windsor J. A. 10, Petrov M. S. 10 ✉
1 Internal Medicine Department, Cardarelli Hospital, Naples, Italy;
2 Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA;
3 Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, FL, USA;
4 Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany;
5 Unit of Digestive System Diseases, Service of Gastroenterology-Pancreatology, Beaujon Hospital, Clichy, France;
6 Service of Intensive Medicine B, Navarra Hospital, Pamplona, Spain;
7 Division of Gastroenterology, Tohoku University Graduate School of Medicine Sendai, Japan;
8 Department of Surgery, Manchester Royal Infirmary, University of Manchester, Manchester, UK;
9 Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Department of Cell Biology and Molecular Physiology, and Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA;
10 Department of Surgery, The University of Auckland, Auckland, New Zealand
Aim: The aim of this paper was to present the 2013 Italian edition of a new international classification of acute pancreatitis severity. The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity.
Methods: A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis. A global web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions.
Results: The new international classification is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical.
Conclusion: This classification provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research.