New Atlanta Classification of acute pancreatitis in intensive care unit: Complications and prognosis

• 21% of patients admitted to ICU for acute pancreatitis (AP) are moderately severe.
• All the patients with moderately severe AP admitted to ICU have complications.
• Most patients with moderately severe AP have non-infectious systemic complications.
• 66.7% of patients with moderately severe AP suffer an infectious complication.
• ICU mortality in patients with moderately severe acute pancreatitis is very low.

BackgroundThe updated Atlanta Classification of acute pancreatitis (AP) in adults defined three levels of severity according to the presence of local and/or systemic complications and presence and length of organ failure. No study focused on complications and mortality of patients with moderately severe AP admitted to intensive care unit (ICU). The main aim of this study is to describe the complications developed and outcomes of these patients and compare them to those with severe AP.MethodsProspective, observational study. We included patients with acute moderately severe or severe AP admitted in a medical–surgical ICU during 5 years. We collected demographic data, admission criteria, pancreatitis etiology, severity of illness, presence of organ failure, local and systemic complications, ICU length of stay, and mortality.ResultsFifty-six patients were included: 12 with moderately severe AP and 44 with severe. All patients developed some kind of complications without differences on complications rate between moderately severe or severe AP. All the patients present non-infectious systemic complications, mainly acute respiratory failure and hemodynamic failure. 82.1% had an infectious complication, mainly non-pancreatic infection (66.7% on moderately severe AP vs. 79.5% on severe, p = 0.0443). None of the patients with moderately severe AP died during their intensive care unit stay vs. 29.5% with severe AP (p = 0.049).ConclusionsModerately severe AP has a high rate of complications with similar rates to patients with severe AP admitted to ICU. However, their ICU mortality remains very low, which supports the existence of this new group of pancreatitis according to their severity.