ABSTRACT
OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
Subject(s)
Amylases/blood , Pancreatitis, Acute Necrotizing/diagnosis , Aged , Biomarkers/blood , Disease Progression , Female , Follow-Up Studies , Humans , Length of Stay/trends , Male , Middle Aged , Pancreatitis, Acute Necrotizing/blood , Pancreatitis, Acute Necrotizing/mortality , Prognosis , Prospective Studies , Severity of Illness Index , Spain/epidemiology , Survival Rate/trends , Tomography, X-Ray ComputedSubject(s)
Abdominal Pain/surgery , Gastrectomy , Gastritis/surgery , Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Gastritis/complications , Gastritis/diagnostic imaging , Gastritis/pathology , Humans , Male , Middle Aged , Radiography, Abdominal , Stomach/diagnostic imaging , Stomach/pathology , Stomach/surgery , Tomography, X-Ray ComputedABSTRACT
In the last decade, advances in the diagnosis and treatment of breast cancer have achieved a significant increase in the general and disease-free survival of affected women but have also increased the complexity of therapeutic decisions. The decision-making process requires agreement between the physicians involved in the management of these patients. Radiologists must understand what other physicians expect and inform them about the usefulness of imaging modalities. This review attempts to provide an update on these subjects.
