The Atlanta 2012 versus the Determinant-Based Classifications for Acute Pancreatitis: Which One is Better?

Abstract

Objective: New research on Acute Pancreatitis (AP) led to new classifications of this unpredictable disease and presently two of them are disputing the supremacy. Our aim is to compare the Atlanta 2012 Classification with the Determinant Based Classification in terms of clinical applicability and accuracy. Method: We performed retrospective analysis of all consecutive cases of AP managed in our tertiary, universityaffiliated emergency center during a period of 12 months. The patients were divided into severity groups according to the Atlanta 2012 and the Determinant-Based Classification. The main outcomes that we used for evaluation were hospital length of stay (H_LOS), intensive care unit (ICU) admission, ICU length of stay (ICU_LOS) and mortality. Results: 226 patients met the inclusion criteria. Most of the patients are male (61.9%), on the sixth decade of life (mean age: 53.8), biliary stones being the most common etiology of AP (39.4%). Using the aria under the curve (AUC) to compare the predictive accuracy of ICU Admission we found that AUC for the Determinant Based Classification is higher compared to AUC for the Atlanta 2012 (0.973 versus 0.961). AUC is similar for both the Atlanta 2012 Classification and DBC in predicting mortality (0.986 and 0.984 respectively). Both classifications provided similar results considering H_LOS and ICU_LOS. Conclusions: The Atlanta 2012 and the DBC both predict with increased accuracy the clinical prognosis of patients with AP. The Determinant Based Classification has a slight advantage over the Atlanta 2012 Classification because it succeeded in offering a better prediction for the ICU Admission and ICU_LOS. Although their clinical applicability is similar, there are few aspects that can be improved and worldwide consensus is necessary for uniformity of scientific research.