CLASSIFICATION AND TREATMENT OF LOCAL SEPTIC COMPLICATIONS IN ACUTE-PANCREATITIS

BACKGROUND: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatit is that classifies all local septic complications into three groups: i nfected necrosis (IN), sterile necrosis (SN), and pancreatic abscess ( PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this Study was to investigate the pro gnostic and therapeutic utility of applying this clinical classificati on system to a large group of surgical patients with local septic comp lication from acute pancreatitis. PATIENTS AND METHODS: We reviewed th e cases of 62 patients with complicated pancreatitis, classifying them into IN (0 = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated with in the first 48 hours of admission. Information on patient demographic s, etiology of pancreatitis, operative procedures, timing of intervent ion, bacteriology, blood loss, intensive care unit days, ventilator da ys, and morbidity and mortality were also accrued and analyzed. RESULT S: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were pat ients with PA (APACHE II score >15, 21% versus 0%, respectively), requ ired earlier operative intervention (mean 14 days versus 29 days, P = 0.02), required necrosectomy with drainage (65% versus 4%, P <0.001) r ather than Simple drainage (3% versus 86%, P (0.001), more reoperation s (2.3 versus 1.1, P <0.05), and had a Significantly higher mortality rate (35% versus 4%, P <0.05). In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusi ons than either patients with SN or PA (P <0.05). CONCLUSIONS: We conc lude that this classification system allows for the stratification of patients into three distinct groups-infected necrosis, sterile necrosi s, and pancreatic abscess- and has both therapeutic and prognostic use fulness.