Acute pancreatitis is classified into mild and severe disease according to criteria found by the Atlanta consensus conference. We investigated whether these criteria correlate with mortality as well as the rate in infected necrosis (IN).
Methods Data of 260 patients with necrotizing pancreatitis were analysed. It was recorded how many of the following Atlanta criteria applied to each patient during hospital stay: APACHE II score 8pts., Ranson 3pts., pulm. insufficiency, renal insufficiency, shock, GI-bleeding, hypocalcaemia or coagulopathy (definitions given in 1)). Patients were classified into different groups according to the number of positive criteria. Mortality and the rate of IN of each group was compared to the incidence of this complication in the overall patient population.
Results 57 pats. died (21.9%); IN was present in 86 pats (33.1%).Classification of patients according to the number of positive criteria is given in the table. Patients had to fulfill at least 2 criteria to have a risk of death comparable to that of the overall population and at least 7 or more complications for an increasesd risk. The incidence of IN is not affected by the number of complications.
Conclusions It is a major drawback of the Atlanta classification of severe acute pancreatitis that patients with one or two complications are classified as suffering from severe attacks despite of having an under-average risk of death. 1)Bradley E.L., Arch. Surg. 1993;128:586-590
No. of positive criteria No. of patients Mortality Rate of infected necrosis
0 31 0*) 3 pats. (10%)*)
1 24 1 pat. (4%)*) 6 pats. (25%)
2 36 2 pats. (6%) 14 pats. (39%)
3 40 5 pats. (13%) 19 pats. (48%)
4 45 10 pats. (22%) 15 pats. (33%)
5 28 6 pats. (21%) 11 pats. (39%)
6 19 8 pats. (42%) 6 pats. (31%)
7 37 25 pats. (68%)*) 12 pats. (32%)
*) p<0.05 vs. overall population