Evolving Definitions of Severe Acute Pancreatitis

  • John A. WindsorEmail author
  • Maxim S. Petrov


Definitions are important to the advancement of science and are always best considered as “working definitions” since science is iterative and our understanding of disease and severity determinants continues to evolve. This chapter provides a historical overview of the evolution of the definitions of acute pancreatitis severity before discussing the revised Atlanta classification of severity and some of the persisting problems with it. The determinants-based classification of severity, which is founded on the epidemiological concept of causal inference, is easy to use and early studies confirm its validity. The comparative performance of these two ways to classify the severity of acute pancreatitis requires further study and this chapter finishes by providing nine research priorities as a way forward. Such research is vital for meaningful communication between clinicians and the accurate allocation of patients to clinical trials, both of which are necessary to improve patient outcomes.


Acute Pancreatitis Organ Failure Acute Pancreatitis Severe Acute Pancreatitis Pancreatic Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Lerch MM. Classifying an unpredictable disease: the revised Atlanta classification of acute pancreatitis. Gut. 2013;62:2–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Whitcomb DC. Acute pancreatitis. N Engl J Med. 2006;354:2142–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Windsor JA, Petrov MS. Acute pancreatitis reclassified. Gut. 2013;62(1):4–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Bradley EL. A clinically based classification system for acute pancreatitis. Arch Surg. 1993;128:586–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Dellinger EP, Forsmark CE, Layer P, Levy P, Maravi-Poma E, Petrov MS, et al. Determinants-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg. 2012;256:875–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Sarner M, Cotton PB. Definitions of acute and chronic pancreatitis. Clin Gastroenterol. 1984;13:865–70.PubMedGoogle Scholar
  8. 8.
    Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Gastroenterology. 1985;89:683–5.PubMedGoogle Scholar
  9. 9.
    Sarles H, Adler G, Dani R, et al. The pancreatitis classification of Marseilles-Rome 1988. Scand J Gastroenterol. 1989;24(6):641–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Gress TM, El-Omar EM. Revision of the Atlanta classification of acute pancreatitis: the editorial perspective. Gut. 2013;62:1.PubMedCrossRefGoogle Scholar
  11. 11.
    Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. 2010;139:813–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000;232(5):619–26.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Garg PK, Madan K, Pande GK, Khanna S, Sathyanarayan G, Bohidar NP, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol. 2005;3(2):159–66.PubMedCrossRefGoogle Scholar
  14. 14.
    McKay CJ, Imrie CW. The continuing challenge of early mortality in acute pancreatitis. Br J Surg. 2004;91(10):1243–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Beger HG, Bittner R, Block S, Buchler M. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. 1986;91(2):433–8.PubMedGoogle Scholar
  16. 16.
    Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol. 2007;102(12):2688–95.PubMedCrossRefGoogle Scholar
  17. 17.
    Mole DJ, Olabi B, Robinson V, Garden OJ, Parks RW. Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HPB. 2009;11(2):166–70.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Loveday BPT, Srinivasa S, Vather R, Mittal A, Petrov MS, Phillips ARJ, Windsor JA. High quantity and variable quality of guidelines for acute pancreatitis: a systematic review. Am J Gastroenterol. 2010;105:1466–76.PubMedCrossRefGoogle Scholar
  19. 19.
    Ishikawa K, Idoguchi K, Tanaka H, Tohma Y, Ukai I, Watanabe H, et al. Classification of acute pancreatitis based on retroperitoneal extension: application of the concept of interfascial planes. Eur J Radiol. 2006;60(3):445–52.PubMedCrossRefGoogle Scholar
  20. 20.
    Petrov MS, Vege SS, Windsor JA. Global survey of controversies in classifying the severity of acute pancreatitis. Eur J Gastroenterol Hepatol. 2012;24(6):715–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Thandassery RB, Yadav TD, Dutta U, Appasani S, Singh K, Kochhar R. Prospective validation of 4-category classification of acute pancreatitis severity. Pancreas. 2013;42(3):392–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Petrov M, Windsor JA. Classification of the severity of acute pancreatitis: how many categories make sense? Am J Gastroenterol. 2010;105(1):74–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Nawaz H, Mounzer R, Yadav D, Yabes JG, Slivka A, Whitcomb DC, Papachristou GI. Revised Atlanta and determinant based classification: application in a prospective cohort of acute pancreatitis patients. Am J Gastroenterol. 2013;108(12):1911–7. doi: 10.1038/ajg.2013.348.PubMedCrossRefGoogle Scholar
  24. 24.
    Pencina MJ, D'Agostino Sr RB, Demler OV. Novel metrics for evaluating improvement in discrimination: net reclassification and integrated discrimination improvement for normal variables and nested models. Stat Med. 2012;31:101–13.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, et al. Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology. 2004;126(3):715–23.PubMedCrossRefGoogle Scholar
  26. 26.
    Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol. 2012;107:612–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Frey CF. Classification of pancreatitis: state-of-the-art 1986. Pancreas. 1986;1:62–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of SurgeryThe University of AucklandAucklandNew Zealand

Personalised recommendations