Acute pancreatitis gravity predictive factors: which and when to use them?

Relationship between salusin beta levels and the severity of acute pancreatitis in patients

BACKGROUND

This study aimed to evaluate the significance of serum salusin beta (SAL-β) levels in predicting the severity of acute pancreatitis (AP) in patients diagnosed with this condition and to assess its relationship with disease and prognosis.

METHODS

Sixty-four patients between 18 and 100 years of age diagnosed with AP, were included in the study. Patients were categorized into 3 groups based on the Revised Atlanta Classification: mild, moderate, and severe AP. Eighteen healthy adults were included as the control group. Sex, age, height, weight, presence of additional diseases, laboratory results, imaging findings, levels of white blood cells, neutrophil-lymphocyte ratio, mean platelet volume, amylase, lipase, sensitive C-reactive protein, sedimentation, and serum SAL-β were measured and recorded. SAL-β levels were reevaluated on the third day of hospitalization.

RESULTS

The average age of the patients included in the study was 62.66 ± 17.67. Gallstones were present in 64.1% of the patients. The difference in the SAL-β averages on the 1st and 3rd days was statistically significant (P < .05). On the first day, the SAL-β averages of those with severe Atlanta scores were higher than those with mild and moderate Atlanta severity. Similarly, on the third day, the SAL-β averages of those with severe Atlanta scores were higher than those with mild and moderate Atlanta severity. According to receiver operating characteristic analysis using the Youden index, the cutoff value for SAL-β for severe pancreatitis was 178.8 pg/mL on the 1st day and 207.5 pg/mL on the 3rd day.

CONCLUSION

SAL-β can be used to detect and monitor severe pancreatitis. Further extensive clinical studies with larger case series are needed.

Development and validation of a nomogram for predicting survival in patients with acute pancreatitis

BACKGROUND

Acute pancreatitis (AP) is a complex and heterogeneous disease. We aimed to design and validate a prognostic nomogram for improving the prediction of short-term survival in patients with AP.

METHODS

The clinical data of 632 patients with AP were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The nomogram for the prediction of 30-day, 60-day and 90-day survival was developed by incorporating the risk factors identified by multivariate Cox analyses.

RESULTS

Multivariate Cox proportional hazard model analysis showed that age (hazard ratio [HR]=1.06, 95% confidence interval [95% CI] 1.03-1.08, P<0.001), white blood cell count (HR=1.03, 95% CI 1.00-1.06, P=0.046), systolic blood pressure (HR=0.99, 95% CI 0.97-1.00, P=0.015), serum lactate level (HR=1.10, 95% CI 1.01-1.20, P=0.023), and Simplified Acute Physiology Score II (HR=1.04, 95% CI 1.02-1.06, P<0.001) were independent predictors of 90-day mortality in patients with AP. A prognostic nomogram model for 30-day, 60-day, and 90-day survival based on these variables was built. Receiver operating characteristic (ROC) curve analysis demonstrated that the nomogram had good accuracy for predicting 30-day, 60-day, and 90-day survival (area under the ROC curve: 0.796, 0.812, and 0.854, respectively; bootstrap-corrected C-index value: 0.782, 0.799, and 0.846, respectively).

CONCLUSION

The nomogram-based prognostic model was able to accurately predict 30-day, 60-day, and 90-day survival outcomes and thus may be of value for risk stratification and clinical decision-making for critically ill patients with AP.

Serum soluble T cell immunoglobulin mucin domain-3 as an early predictive marker for severity of acute pancreatitis; a retrospective analysis

BACKGROUND

Early prediction of severe acute pancreatitis (SAP) plays an important role in timely treatment decisions. Soluble T cell immunoglobulin and mucin domain-3 (sTIM-3) has been applied as a potential biomarker for the prediction of many diseases, while its predictive ability for AP severity remains largely unexplored. In this study, we aimed to identify whether serum sTIM-3 could be used as an indicator of AP severity in the early stage of the disease.

METHODS

A retrospective study was conducted. The enrolled AP patients should meet the 2012 Atlanta guideline and have an onset to admission ≤ 48 h.

RESULTS

A total of 94 AP patients were enrolled in the current analysis, including 42 (45%), 35 (37%), and 17 (18%) patients were diagnosed as mild AP (MAP), moderately SAP (MSAP), and SAP, respectively. SAP patients had significantly higher the white blood cells (WBCs) count, red blood cells (RBCs) count, C-reactive protein (CRP) level, direct bilirubin level, creatinine and procalcitonin levels compared with MAP and MSAP patients. Among SAP and MSAP patients, significantly higher APACHE II, BISAP, and MCTSI scores were observed compared with MAP patients, and there was significant difference in APACHE II and BISAP scores between SAP and MSAP patients. Stepwise multivariate linear regression analysis showed that the concentrations of serum sTIM-3, as well as the BISAP and MCTSI scores, were significantly associated with the severity of AP. The areas under the ROC curve were 0.914 (95% CI, 0.865-0.963), 0.855 (95%CI, 0.742-0.968) 0.853 (95%CI, 0.768-0.938), and 0.746 (95%CI, 0.633-0.860) for BISAP score, APACHE II score, sTIM-3 level, and MCTSI score, respectively.

CONCLUSIONS

Serum sTIM-3 might be ultimately incorporated into a predictive system for assessing the severity of AP.

DIFFERENTIAL DIAGNOSIS BETWEEN BILIARY AND NONBILIARY ACUTE PANCREATITIS: WHAT IS THE IMPORTANCE OF LABORATORY TESTS?

BACKGROUND

The differential diagnosis of the causal factors of acute pancreatitis is fundamental for its clinical follow-up, becoming relevant to establishing laboratory criteria that elucidate the difference between biliary and nonbiliary causes.

AIM

The aim of this study was to establish criteria based on laboratory tests for the differential diagnosis between acute pancreatitis of biliary and nonbiliary causes and to identify laboratory tests with sufficient sensitivity to propose the creation of an algorithm for differential diagnosis between the causes.

METHODS

The research consisted of observational analysis, with a cross-sectional design of laboratory tests of two groups of patients with acute pancreatitis: group A: nonbiliary cause and group B: biliary cause. Hematocrit, white blood cell count, lactate dehydrogenase, glucose, lipase, amylase, total bilirubin, oxalacetic transaminase, pyruvic transaminase, gamma-glutamyltransferase, and alkaline phosphatase were investigated. Data were submitted to nonparametric tests and receiver operating characteristics.

RESULTS

Hematocrit values, number of leukocytes, lactate dehydrogenase, and glucose showed no significant difference between the groups (p>0.1). Lipase, amylase, total bilirubin, oxalacetic transaminase, pyruvic transaminase, gamma-glutamyltransferase, and alkaline phosphatase values showed a significant difference between groups (p<0.05). The oxalacetic transaminase, pyruvic transaminase, and alkaline phosphatase tests were most sensitive in determining the biliary cause, allowing the establishment of a cutoff point by the receiver operating characteristic test: pyruvic transaminase: 123.0 U/L (sensitivity: 69.2%; specificity: 81.5%), oxalacetic transaminase: 123.5 U/L (sensitivity: 57.3%; specificity: 78.8%), and alkaline phosphatase: 126.5 U/L (sensitivity: 66.1%; specificity: 69.4%), from which the probability of a correct answer increases.

CONCLUSION

It was possible to establish criteria based on laboratory tests for the differential diagnosis between acute pancreatitis of biliary and nonbiliary origin; however, the tests did not show enough sensitivity to propose the creation of an algorithm for differential diagnosis between the same causes.

A prediction model with measured sentiment scores for the risk of in-hospital mortality in acute pancreatitis: a retrospective cohort study

Background

Accurate and prompt clinical assessment of the severity and prognosis of patients with acute pancreatitis (AP) is critical, particularly during hospitalization. Natural language processing algorithms gain an opportunity from the growing number of free-text notes in electronic health records to mine this unstructured data, e.g., nursing notes, to detect and predict adverse outcomes. However, the predictive value of nursing notes for AP prognosis is unclear. In this study, a predictive model for in-hospital mortality in AP was developed using measured sentiment scores in nursing notes.

Methods

The data of AP patients in the retrospective cohort study were collected from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Sentiments in nursing notes were assessed by sentiment analysis. For each individual clinical note, sentiment polarity and sentiment subjectivity scores were assigned. The in-hospital mortality of AP patients was the outcome. A predictive model was built based on clinical information and sentiment scores, and its performance and clinical value were evaluated using the area under curves (AUCs) and decision-making curves, respectively.

Results

Of the 631 AP patients included, 88 cases (13.9%) cases were dead in hospital. When various confounding factors were adjusted, the mean sentiment polarity was associated with a reduced risk of in-hospital mortality in AP [odds ratio (OR): 0.448; 95% confidence interval (CI): 0.233–0.833; P=0.014]. A predictive model was established in the training group via multivariate logistic regression analysis, including 12 independent variables. In the testing group, the model showed an AUC of 0.812, which was significantly greater than the sequential organ failure assessment (SOFA) of 0.732 and the simplified acute physiology score-II (SAPS-II) of 0.792 (P<0.05). When the same level of risk was considered, the clinical benefits of the predictive model were found to be the highest compared with SOFA and SAPS-II scores.

Conclusions

The model combined sentiment scores in nursing notes showed well predictive performance and clinical value in in-hospital mortality of AP patients.

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a feared and potentially fatal complication that can be as high as up to 30% in high-risk patients. Pre-examination measures, during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events. Several studies have debated on the subject, however, numerous topics remain controversial, such as the effectiveness of prophylactic medications and the amylase dosage time. This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

THE ACCEPTANCE OF CHANGES IN THE MANAGEMENT OF PATIENTS WITH ACUTE PANCREATITIS AFTER THE REVISED ATLANTA CLASSIFICATION

BACKGROUND

New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012.

OBJECTIVE

The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices.

METHODS

A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: "Acute pancreatitis" AND "Atlanta". Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study.

RESULTS

Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification.

CONCLUSION

Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn't enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.

Assessment of severity of acute pancreatitis over time

In recent years there has been an increase in the incidence of acute pancreatitis worldwide. In spite of efforts to improve the treatment and care of patients with acute pancreatitis, to develop imaging investigations and interventional diagnostic and treatment techniques and to facilitate patients' access to them, acute pancreatitis continues to be associated with significant mortality and morbidity, and the treatment of patients suffering from this disease entails significant costs for healthcare systems. Researchers are in a permanent quest to get to a global consensus for stratifying the severity of acute pancreatitis. We need this in order to offer the proper management for each patient diagnosed with this condition and to improve hospital and health system strategies. Over the years, it has been attempted to develop algorithms to support a swift assessment of patients with acute pancreatitis with a prediction of disease severity as close to reality as possible for optimal management. This has led to the development of classifications of severity and severity scores. These require a permanent updating to keep up with the technical and technological developments involved in investigating and treating the patient and encompassing the most recent studies. The goal of this paper is to go through these classifications and scores, emphasizing factors that should be taken into account, and reflecting upon their utility and upon the necessity of improving them.

Clinical Significance of Inflammation Markers in Predicting the Severity of Acute Pancreatitis

OBJECTIVES

Acute pancreatitis (AP) is an inflammatory disease of the pancreas. We analyzed changes in inflammation markers to explore the clinical significance of using these markers to predict the severity of AP.

METHODS

The study included 169 patients (severe AP = 50 and nonsevere AP = 119) admitted to Yanbian University Hospital between January 2015 and July 2017. The neutrophil-to-lymphocyte ratio (NLR), prognostic nutrition index (PNI), lymphocyte-to-monocyte ratio, red blood cell distribution width coefficient of variation, mean platelet volume, platelet-to-lymphocyte ratio, and red blood cell distribution width-to-platelet ratio of the patients were detected after admission. Correlations between AP severity and various inflammatory markers were statistically analyzed.

RESULTS

The results indicated that the NLR on the first day after admission (area under the curve, 0.824; 95% confidence interval, 0.753-0.896) and the PNI on the third day after admission (area under the curve, 0.814; 95% confidence interval, 0.753-0.896) had more significance than other inflammation markers in predicting the severity of AP. In AP patients, the NLR showed a gradual decline, and the PNI initially decreased and then increased.

CONCLUSIONS

The NLR and PNI can provide new reference values for predicting the severity of AP.

Factors predicting the severity of acute pancreatitis in elderly patients

BACKGROUND

Moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) are associated with organ failure (OF), which can be lethal.

AIMS

This study determined the factors that predict the severity of AP at admission in elderly patients.

METHODS

In this retrospective study, the data from elderly patients (> 60 years of age) admitted within 72 h of onset of symptoms without OF were collected. These data at admission were analyzed and correlated with the severity of AP. To identify the factors associated with more serious AP (i.e. MSAP and SAP), patients were divided into mild acute pancreatitis (MAP) and MSAP + SAP groups.

RESULTS

A total of 198 patients [MAP group (n = 135) and MSAP + SAP group (n = 63)] were included. Biliary disease was the most common etiology. Respiratory failure was the most common OF. Logistic regression analyses indicated that idiopathic etiology (odds ratio [OR]: 3.029, 95% confidence interval [CI]: 1.017-9.022, p = 0.047), pre-existing pulmonary disease (OR: 7.104, CI 1.750-28.84, p = 0.006), increased hematocrit level (OR: 3.717, 95%CI 1.372-10.070, p = 0.010), serum calcium (OR: 0.023, 95%CI 0.001-0.371, p = 0.008), serum glucose (OR: 1.157, 95%CI 1.031-1.299, p = 0.013), arterial partial pressure of oxygen (PaO₂) (OR: 0.914, 95%CI 0.874-0.956, p < 0.001), and pleural effusion (OR: 4.979, 95%CI 1.863-13.303, p = 0.001) were independent predictors of more serious AP.

CONCLUSION

This study found that idiopathic etiology, pre-existing pulmonary diseases, increased hematocrit level or pleural effusion, higher serum glucose, and lower serum calcium or PaO₂ at the time of admission independently correlated with more serious AP in the elderly patients.

Association between sedation level and mortality of intensive care patients on mechanical ventilation

OBJECTIVE

To associate the sedation level, criteria for daily interruption of sedation and mortality of patients on mechanical ventilation in an Intensive Care Unit.

METHOD

Prospective, longitudinal and quantitative study conducted with patients by using the Richmond Agitation-Sedation Scale (RASS) and the Sepsis-related Organ Failure Assessment (SOFA) score, through a care protocol managed by a nurse at the unit for the daily interruption of sedation once a day. The Chi Square test was used to check the association between variables and the T test for independent analyzes.

RESULTS

Participation of 204 patients. Most were male, surgical, aged between 40 and 60 years, in sedoanalgesia with fentanyl, midazolam and propofol, with sedation time of one to five days and average stay of 10.7 days. They were in moderate sedation and at high risk for mortality. There was a statistical correlation between death in patients in deep sedation, and sensitivity in relation to discharge from the Intensive Care Unit of those who underwent daily interruption of sedation and were reassessed daily.

CONCLUSION

Daily interruption of sedation guided by the Richmond Agitation-Sedation Scale assists in the control of sedation, which favors the treatment and recovery of patients and guides nurses' decision making. However, in this study, it was not configured as an independent factor for predicting mortality in intensive care.

Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis

Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.

Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis

Background and study aims  Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for treatment of diseases that affect the biliary tree and pancreatic duct. While the therapeutic success rate of ERCP is high, the procedure can cause complications, such as acute pancreatitis (PEP), bleeding, and perforation. This meta-analysis aimed to assess the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing PEP following (ERCP). Materials and methods  We searched databases, such as MEDLINE, Embase, and Cochrane Central Library. Only randomized controlled trials (RCTs) that compared the efficacy of NSAIDs and placebo for the prevention of PEP were included. Outcomes assessed included incidence of PEP, severity of pancreatitis, route of administration, and type of NSAIDs. Results  Twenty-one RCTs were considered eligible with a total of 6854 patients analyzed. Overall, 3427 patients used NSAIDs before ERCP and 3427 did not use the drugs (control group). In the end, 250 cases of acute pancreatitis post-ERCP were diagnosed in the NSAIDs group and 407 cases in the placebo group. Risk for PEP was lower in the NSAID group (risk difference (RD): -0.05; 95 % confidence interval (CI): -0.07 to - 0.03; number need to treat (NNT), 20; P  < 0.05). Use of NSAIDs effectively prevented mild pancreatitis compared with use of placebo (2.5 % vs. 4.1 %; 95 % CI, -0.05 to - 0.01; NNT, 33; P  < 0.05), but the information on moderate and severe PEP could not be completely elucidated. Only rectal administration reduced incidence of PEP (6.8 % vs. 13 %; 95 % CI, -0.10 to - 0.04; NNT, 20; P  < 0.05). Furthermore, only diclofenac or indomethacin use was effective in preventing PEP. Conclusions  Rectal administration of diclofenac and indomethacin significantly reduced risk of developing mild PEP. Further RCTs are needed to compare efficacy between NSAID administration pathways in prevention of PEP after ERCP.

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis

BACKGROUND

Serum C-reactive protein (CRP) increases and albumin decreases in patients with inflammation and infection. However, their role in patients with acute pancreatitis is not clear. The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.

METHODS

This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015. Ranson scores, Atlanta classification and CRP/albumin ratios of the patients were calculated.

RESULTS

The CRP/albumin ratio was higher in deceased patients compared to survivors. The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time, CRP and erythrocyte sedimentation rate. In addition to the CRP/albumin ratio, necrotizing pancreatitis type, moderately severe and severe Atlanta classification, and total Ranson score were independent risk factors of mortality. It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk. A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity. It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28. Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.

CONCLUSION

The CRP/albumin ratio is a novel but promising, easy-to-measure, repeatable, non-invasive inflammation-based prognostic score in acute pancreatitis.

Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis

To assess the association between the clinical parameters within 48 hours of admission and the occurrence of infected pancreatic necrosis (IPN) during the late phase of necrotizing pancreatitis (NP).All patients were divided into 2 groups, the IPN and non-IPN groups. The clinical data were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between clinical parameters and IPN secondary to NP. The performance of each independent variable was plotted by the receiver-operating characteristic (ROC) curve. Consequently, the cut-off level of each independent variable with its sensitivity and specificity was calculated.A total of 215 patients were enrolled in our study. Among them, 87 (40.5%) patients developed IPNs after a median of 13.5 (9.5-23.0) days from admission. Multivariate analysis indicated that the level of hematocrit (HCT) from 40% to 50% (P=.012, odds ratio (OR) = 2.407), HCT over 50% (P < .009, OR = 6.794), blood urea nitrogen (BUN) (P = .040, OR = 1.894), C-reactive protein (CRP) (P = .043, OR = 1.837), and procalcitonin (PCT) (P = .002, OR = 2.559) were independent risk factors of IPN secondary to NP. The ROC cures revealed that the area under the ROC (AUC) of the maximum level of HCT, BUN, CRP, and PCT within 48 hours of admission was 0.687, 0.620, 0.630, and 0.674 respectively. Furthermore, the combination of these 4 individual parameters contributes to a more preferable AUC of 0.789 with a sensitivity of 67.8% and specificity of 77.3%.The maximum levels of PCT, CRP, HCT, and BUN within 48 hours of admission are independent factors of IPN and their combination might accurately predict the occurrence of IPN secondary to NP.

UNDERSTANDING THE INTERNATIONAL CONSENSUS FOR ACUTE PANCREATITIS: CLASSIFICATION OF ATLANTA 2012

Introduction:

Contrast computed tomography and magnetic resonance imaging are widely used due to its image quality and ability to study pancreatic and peripancreatic morphology. The understanding of the various subtypes of the disease and identification of possible complications requires a familiarity with the terminology, which allows effective communication between the different members of the multidisciplinary team.

Aim:

Demonstrate the terminology and parameters to identify the different classifications and findings of the disease based on the international consensus for acute pancreatitis ( Atlanta Classification 2012).

Methods:

Search and analysis of articles in the "CAPES Portal de Periódicos with headings "acute pancreatitis" and "Atlanta Review".

Results:

Were selected 23 articles containing radiological descriptions, management or statistical data related to pathology. Additional statistical data were obtained from Datasus and Population Census 2010. The radiological diagnostic criterion adopted was the Radiology American College system. The "acute pancreatitis - 2012 Rating: Review Atlanta classification and definitions for international consensus" tries to eliminate inconsistency and divergence from the determination of uniformity to the radiological findings, especially the terminology related to fluid collections. More broadly as "pancreatic abscess" and "phlegmon" went into disuse and the evolution of the collection of patient fluids can be described as "acute peripancreatic collections", "acute necrotic collections", "pseudocyst" and "necrosis pancreatic walled or isolated".

Conclusion:

Computed tomography and magnetic resonance represent the best techniques with sequential images available for diagnosis. Standardization of the terminology is critical and should improve the management of patients with multiple professionals care, risk stratification and adequate treatment.