Validation of Modified Determinant-Based Classification of severity for acute pancreatitis in a tertiary teaching hospital

Background: The relative merits of two recent classifications of acute pancreatitis severity, the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC), have been debated. A Modified DBC (MDBC) was recently proposed in intensive care unit (ICU) patients. By dividing the DBC 'severe' category into two groups, the MDBC classified non-mild acute pancreatitis into 4 groups rather than 2 in RAC and 3 in DBC. In this study we aim to validate MDBC in both ICU and non-ICU patients and evaluate infected necrosis as a determinant of severity. Methods: Prospective data collected on consecutive patients admitted to a tertiary teaching hospital were retrospectively analyzed. Patients were assigned to the categories of severity defined by the DBC, RAC and MDBC. Clinical interventions and outcomes were compared between categories. Results: A total of 1102 patients were enrolled and the overall mortality was 5.7%. When MDBC was applied, the four Groups were significantly different in regard to ICU admission rates (30%, 40%, 69% and 87%) and mortality (2%, 15%, 40% and 57%). Groups 2 and 3 were different in intervention rates and morbidity, providing evidence that IN is an important determinant of severity. Conclusions: This study validates the MDBC proposal to subdivide the DBC 'severe' category into two groups for ICU and non-ICU patients in a tertiary hospital. (C) 2019 Published by Elsevier B.V. on behalf of IAP and EPC.