• Contact us
  • E-Submission

Ewha Med J : The Ewha Medical Journal

OPEN ACCESS
mobile search button mobile menu button
Search
Advanced Search
ABOUT
BROWSE ARTICLES
JOURNAL POLICIES
FOR CONTRIBUTORS

Articles

Page Path

Original Article

Clinical Significance of New Classification of Mild Acute Pancreatitis

Sun Young Yi, Sun Hee Rho1
The Ewha Medical Journal 2012;35(1):32-37. Published online: March 31, 2012

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

1Vievis Namuh Hospital, Seoul, Korea.

Corresponding author: Sun Young Yi, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-5575, 2680, Fax: 82-2-2655-2076, syy@ewha.ac.kr
• Received: January 31, 2012   • Accepted: March 5, 2012

Copyright © 2012. Ewha Womans University School of Medicine

  • 35 Views
  • 0 Download
prev next

Full Article

Download PDF Download PDF
  • Objectives
    This study aimed to provide an actualized classification system for acute pancreatitis (AP) by applying new principle and investigated the benefits of new classification.
  • Methods
    Medical records and computed tomography (CT) images of 235 consecutive patients with AP admitted to the Ewha Womans University Mokdong Hospital between 2005 and 2010 were reviewed. The patients of severe pancreatitis who has necrosis were only 68 cases, these are too small for comparing to mild form. So we analyzed mild form of pancreatitis preferentially into two groups; group A, without morbidity and without organ failure (145 patients, mild acute pancreatitis, MAP); group B, with morbidity and without organ failure (22 patients, aggressive mild acute pancreatitis, AMAP). Clinical characteristics, laboratory findings, duration of hospitalization, need for the intensive care unit (ICU), organ failure, needs of intervention, another severity indexes and death were evaluated.
  • Results
    AMAP (group B) was higher proportion of need for the ICU care and of organ failure than MAP after age-adjusting (P<0.01). Also AMAP had higher incidence of associated malignancy, pseudocysts, and increasing fasting sugar level.
  • Conclusion
    The AMAP is a different type of MAP. We need new category of different grade of mild form pancreatitis, because AMAP showed different clinical course. New classification of mild acute pancreatitis is relatively effective, and has clinically significant value.
  • Keywords: Acute pancreatitis; Mild form; Classification
  • 1. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379-2400.
  • 2. Uhl W, Warshaw A, Imrie C, Bassi C, Mckay CJ, Lankisch PG, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565-573.
  • 3. Pandol SJ, Saluja AK, Imrie CW, Banks PA. Acute pancreatitis: bench to the bedside. Gastroenterology 2007;132:1127-1151.
  • 4. Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128:586-590.
  • 5. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/faiure. On behalf of the Working Group on Sepsis- Related Problems of the European Society of Inteinsive Care Medicine. Intensive Care Med 1996;22:707-710.
  • 6. Buter A, Imrie CW, Carter CR, Evan S, Mckay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002;89:298-302.
  • 7. Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 2004;53:1340-1344.
  • 8. Acute Pancreatitis Classification Working GroupRevision of the Atlanta classification of acute pancreatitis. 3rd revision 2008;cited 2009 Apr 1. Acute Pancreatitis Classification Working Group. Available from: http://www.pancreasclub.com/resources/AtlantaClassification.pdf
  • 9. Flint R, Windsor JA. Early physiological response to intensive care as a clinically relevant approach to predicting the outcome in severe acute pancreatitis. Arch Surg 2004;139:438-443.
  • 10. Mole DJ, Olabi B, Robinson V, Garden OJ, Parks RW. Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HPB (Oxford) 2009;11:166-170.
  • 11. Lankisch PG. Natural course of acute pancreatitis: what we know today and what we ought to know for tomorrow. Pancreas 2009;38:494-498.
  • 12. Ryu JK. Evaluation of severity in acute pancreatitis. Korean J Gastroenterol 2009;54:205-211.
  • 13. Vege SS, Gardner TB, Chari ST, Munukuti P, Pearson RK, Clain JE, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include "moderately severe acute pancreatitis". Am J Gastroenterol 2009;104:710-715.
  • 14. Pannala R, Kidd M, Modlin IM. Acute pancreatitis: a historical perspective. Pancreas 2009;38:355-366.
  • 15. Gloor B, Muller CA, Worni M, Martiqnoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975-979.
  • 16. Garg PK, Madan K, Pande GK, Khanna S, Sathyanarayan G, Bohidar NP, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol 2005;3:159-166.
  • 17. Beger HG, Rau BM. Severe acute pancreatitis: clinical course and management. World J Gastroenterol 2007;13:5043-5051.
  • 18. Xue P, Deng LH, Zhang ZD, Yang XN, Wan MH, Song B, Xia Q. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci 2009;54:2748-2753.
  • 19. Talukdar R, Clemens M, Vege SS. Moderately severe acute pancreatitis: a prospective validation study of this new subgroup of acute pancreatitis. Pancreas 2012;41:306-309.
  • 20. de-Madaria E, Soler-Sala G, Lopez-Font I, Zapater P, Martinez J, Gomez-Escolar L, et al. Update of the Atlanta classification of severity of acute pancreatitis: should a moderate category be included? Pancreatology 2010;10:613-619.
  • 21. Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000;232:619-626.
  • 22. Lytras D, Manes K, Triantopoulou C, Paraskeva C, Delis S, Avgerinos C, et al. Persistent early organ failure: defining the high-risk group of patients with severe acute pancreatitis? Pancreas 2008;36:249-254.
  • 23. Le Mee J, Paye F, Sauvanet A, O'Toole D, Hammel P, Marty J, et al. Incidence and reversibility of organ failure in the course of sterile or infected necrotizing pancreatitis. Arch Surg 2001;136:1386-1390.
  • 24. Ishikawa K, Idoguchi K, Tanaka H, Tohma Y, Ukai I, Matsuoka T, et al. Classification of acute pancreatitis based on retroperitoneal extension: application of the concept of interfascial planes. Eur J Radiol 2006;60:445-452.
  • 25. Bradley EL III. Confusion in the imaging ranks: time for a change? Pancreas 2006;33:321-322.
Table 1
Suggested new classification of acute pancreatitis

MAP, mild acute pancreatitis; AMAP, aggressive mild acute pancreatitis.

emj-35-32-i001.jpg
Table 2
General characteristics of patients of mild form acute pancreatitis

Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure. BMI, body mass index; ICU, intensive care unit.

emj-35-32-i002.jpg
Table 3
Characteristics of patients of mild form acute pancreatitis based on underlying diseases

Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure.

emj-35-32-i003.jpg
Table 4
Laboratory findings of patients of mild form acute pancreatitis

Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure.

emj-35-32-i004.jpg
Table 5
Clinical scoring systems and index of mild form acute pancreatitis

Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure. CT, computed tomography; SOFA, Sepsis-related Organ Failure Assessment; APACHE, Acute Physiology and Chronic Health Evaluation; BISAP, Bedside Index of Severity in Acute Pancreatitis.

emj-35-32-i005.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      Download Citation

      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:

      Include:

      Clinical Significance of New Classification of Mild Acute Pancreatitis
      Ewha Med J. 2012;35(1):32-37.   Published online March 31, 2012
      DOI: https://doi.org/10.12771/emj.2012.35.1.32
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Clinical Significance of New Classification of Mild Acute Pancreatitis
      Ewha Med J. 2012;35(1):32-37.   Published online March 31, 2012
      DOI: https://doi.org/10.12771/emj.2012.35.1.32
      Close
      Clinical Significance of New Classification of Mild Acute Pancreatitis
      Clinical Significance of New Classification of Mild Acute Pancreatitis

      Suggested new classification of acute pancreatitis

      MAP, mild acute pancreatitis; AMAP, aggressive mild acute pancreatitis.

      General characteristics of patients of mild form acute pancreatitis

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure. BMI, body mass index; ICU, intensive care unit.

      Characteristics of patients of mild form acute pancreatitis based on underlying diseases

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure.

      Laboratory findings of patients of mild form acute pancreatitis

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure.

      Clinical scoring systems and index of mild form acute pancreatitis

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure. CT, computed tomography; SOFA, Sepsis-related Organ Failure Assessment; APACHE, Acute Physiology and Chronic Health Evaluation; BISAP, Bedside Index of Severity in Acute Pancreatitis.
      Table 1 Suggested new classification of acute pancreatitis

      MAP, mild acute pancreatitis; AMAP, aggressive mild acute pancreatitis.

      Table 2 General characteristics of patients of mild form acute pancreatitis

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure. BMI, body mass index; ICU, intensive care unit.

      Table 3 Characteristics of patients of mild form acute pancreatitis based on underlying diseases

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure.

      Table 4 Laboratory findings of patients of mild form acute pancreatitis

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure.

      Table 5 Clinical scoring systems and index of mild form acute pancreatitis

      Group A (mild acute pancreatitis), without morbidity, without organ failure. Group B (aggressive mild acute pancreatitis), with morbidity, without organ failure. CT, computed tomography; SOFA, Sepsis-related Organ Failure Assessment; APACHE, Acute Physiology and Chronic Health Evaluation; BISAP, Bedside Index of Severity in Acute Pancreatitis.

      Table 1

      Table 2

      Table 3

      Table 4

      Table 5

      Ewha Med J : The Ewha Medical Journal

      ABOUT

      BROWSE ARTICLES 

      JOURNAL POLICIES

      FOR CONTRIBUTORS 

      © Ewha Womans University College of Medicine.
      TOP