Pancreas and Biliary TractRevised Atlanta and Determinant-Based Classification: Application in a Prospective Cohort of Acute Pancreatitis PatientsNawaz, Haq MD1; Mounzer, Rawad MD1; Yadav, Dhiraj MD1; Yabes, Jonathan G PhD2; Slivka, Adam MD, PhD1; Whitcomb, David C MD, PhD1; Papachristou, Georgios I MD1, 3Author Information 1 Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA 2 Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 3 Division of Gastroenterology, Department of Medicine, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA Correspondence: Georgios I. Papachristou, MD, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. E-mail: firstname.lastname@example.org Received 21 May 2013; accepted 19 August 2013 published online 15 October 2013 American Journal of Gastroenterology: December 2013 - Volume 108 - Issue 12 - p 1911–1917 doi: 10.1038/ajg.2013.348 Buy Metrics Abstract OBJECTIVES: Atlanta classification (Atlanta 1992) of acute pancreatitis (AP) has several limitations. Two new classification systems were recently proposed: the Atlanta reclassification (Atlanta 2012) and the determinant-based classification (DBC). The aim of our study was to: (i) determine the association between different severity categories and clinical outcomes and (ii) perform a head-to-head comparison between Atlanta 1992, Atlanta 2012, and DBC in predicting these clinical outcomes. METHODS: A total of 256 prospectively enrolled patients were assigned a severity category for all three classifications. Five clinical outcomes were evaluated: mortality, intensive care unit (ICU) admission and length of stay (LOS), need for interventions, and hospital LOS. Pairwise testing between severity grades within a classification system was performed using Fisher's exact and Kruskal–Wallis tests. Predictive accuracies were evaluated using area under the ROC curve (AUC) and Somer's D co-efficient. RESULTS: Overall, higher grades of severity were associated with worse clinical outcomes for all three classification systems. Atlanta 2012 and DBC performed better than Atlanta 1992 and were comparable in predicting mortality (AUC 0.89 for both vs. 0.76,P<0.001), ICU admission (AUC 0.91 for both vs. 0.80,P<0.001), and ICU LOS (Somer's D 0.21 and 0.28 vs. 0.07,P<0.05). DBC performed better in predicting need for interventions (AUC 0.93 vs. 0.85,P<0.001), whereas Atlanta 2012 performed better in predicting hospital LOS (Somer's D 0.43 vs. 0.37,P=0.04). CONCLUSIONS: Atlanta 2012 and DBC severity categories accurately reflected clinical outcomes in our cohort and were superior to Atlanta 1992. These novel classification systems can guide the selection of homogeneous patient populations for clinical research and provide an accurate spectrum of disease severity categories in the clinical setting. © The American College of Gastroenterology 2013. All Rights Reserved.