Determinants of Severity in Acute Pancreatitis: A Nation-wide Multicenter Prospective Cohort Study

Research output: Contribution to journalArticle


OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.


  • Federico Bolado
  • Héctor J. Canaval-Zuleta
  • Carlos Marra-López
  • Ana I. Hernando-Alonso
  • Adolfo Del-Val-Antoñana
  • Guillermo García-Rayado
  • Robin Rivera-Irigoin
  • Francisco J. Grau-García
  • Lluís Oms
  • Judith Millastre-Bocos
  • Isabel Pascual-Moreno
  • David Martínez-Ares
  • Juan A. Rodríguez-Oballe
  • Antonio López-Serrano
  • María L. Ruiz-Rebollo
  • Alejandro Viejo-Almanzor
  • Belén González-de-la-Higuera
  • Aitor Orive-Calzada
  • Ignacio Gómez-Anta
  • José Pamies-Guilabert
  • Fátima Fernández-Gutiérrez-Del-Álamo
  • Isabel Iranzo-González-Cruz
  • Mónica E. Pérez-Muñante
  • María D. Esteba
  • Ana Pardillos-Tomé
  • Pedro Zapater
  • Enrique de-Madaria
External organisations
  • University of Navarra
  • Hospital Son Llàtzer
  • Hospital Universitario Araba
  • Hospital Universitario Quirón
  • University and Polytechnic Hospital la Fe
  • Hospital Arnau de Vilanova
  • Miguel Servet University Hospital
  • Hospital Universitario Doctor Peset
  • University of Valladolid
  • Autonomous University of Barcelona
  • University of Alicante
  • Aragon Health Sciences Institute
  • Hospital Costa del Sol
  • Consorci Sanitari de Terrassa
  • Hospital Meixoeiro
  • University Hospital Virgen Macarena
  • Hospital Puerta del Mar
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Gastroenterology and Hepatology


  • surgery, acute pancreatitis
Original languageEnglish
Pages (from-to)348-355
JournalAnnals of Surgery
Issue number2
Publication statusPublished - 2019
Publication categoryResearch