The "Two-Step" approach for classifying the severity of acute pancreatitis: A retrospective study
The "Two-Step" approach for classifying the severity of acute pancreatitis: A retrospective study
复制标题
急性胰腺炎严重程度分类的“两步”方法：一项回顾性研究
DOI：
10.1002/jhbp.943
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Ting-Bo Liang
中科院分区：
文献类型：
--
作者：
Yun Zhang;Cheng Zhang;Wen-Qiao Yu;Zhi-En Wang;Jian Zhang;Ting-Bo Liang
背景资料：亚特兰大分级（RAC）和基于决定因素的分级（DBC）是目前广泛采用的两种评价急性胰腺炎（AP）严重程度的系统。本研究旨在克服其中存在的不准确性和局限性。方法：回顾性分析298例AP患者的临床资料。“两步”方法分为早期器官衰竭（OF）评估：（I）无，（II）短暂性，（III）单次持续性，（IV）多次持续性;以及后期局部并发症评估：（A）无，（B）无菌，（C）感染。在第二步之前死亡的AP患者被归类为X类。然后将“两步”方法与RAC和DBC进行比较。结果：随着患者等级的增加（I至IV），器官支持治疗率、重症监护室住院时间和死亡率增加。随着局部并发症的加重，侵入性干预率呈上升趋势（A至C）。X类患者年龄较大，马歇尔评分较高，严重程度最高。结论：通过结合早期OF分级和晚期局部并发症，“两步”方法代表了AP分层研究所需的准确分类系统，并引入了X类作为AP的最常见形式。
Background: The Revised Atlanta Classification (RAC) and Determinant-Based Classification (DBC) are currently two widely adopted systems for evaluating the severity of acute pancreatitis (AP). This study aimed to overcome the inaccuracies and limitations that existed in them..Methods: We retrospectively analyzed 298 patients with AP. The "Two-Step" approach was divided into an early organ failure (OF) assessment: (I) none, (II) transient, (III) single persistent, and (IV) multiple persistent; and a later local complications assessment: (A) none, (B) sterile, and (C) infectious. Patients with AP who died before the second step were classified into category X. The "Two-Step" approach was then compared to the RAC and DBC..Results: As the patients' grades increased (I to IV), organ support treatment rates, intensive care unit lengths of stay, and mortalities increased. Invasive intervention rates displayed increasing trends with local complications aggravated (A to C). Patients in category X were older and had higher Marshall scores with the highest grades of severity..Conclusions: By combining the early OF grades and the late local complications, the "Two-Step" approach represents an accurate classification system required for stratified studies of AP, and introduces the category X as the severest forms of AP.