ACUTE PANCREATITIS: SEVERITY CRITERIA, CLASSIFICATION SYSTEMS (REVISED ATLANTA) AND IMPACT ON CLINICAL PROGNOSIS

Abstract

Introduction: Acute pancreatitis is characterized as an inflammatory disorder with a heterogeneous clinical presentation, whose pathophysiology involves early enzymatic activation, resulting in glandular autodigestion and a potential systemic inflammatory response. The disease spectrum ranges from self-limiting edematous forms to complex necrotizing conditions associated with high mortality. In this context, risk stratification has proven critical for therapeutic management, consolidating the Revised Atlanta Classification as the international gold standard in defining severity based on the presence of local complications and the persistence of organ failure. Objective: The objective of this systematic review was to analyze the severity criteria for acute pancreatitis, the applicability of classification systems, with emphasis on the Revised Atlanta Classification, and their respective impacts on the clinical prognosis of patients. Methodology: This systematic review followed the PRISMA checklist guidelines. Searches were conducted in the PubMed, SciELO, and Web of Science databases using the following descriptors: acute pancreatitis, prognosis, severity classification, organ failure, and mortality. Inclusion criteria were: complete original articles, studies published in the last decade, and texts in English or Portuguese. Exclusion criteria included: duplicate records across databases, editorials or letters to the editor, and research conducted exclusively with animal models. Results: The analyzed data demonstrated that the Revised Atlanta Classification allowed for superior prognostic distinction by categorizing the disease as mild, moderately severe, and severe. Persistent organ failure for more than 48 hours was the primary determinant of mortality, overriding traditional multifactorial scores in predicting fatal outcomes. Furthermore, the presence of infected pancreatic necrosis correlated directly with prolonged hospitalization and the need for invasive interventions, reinforcing the importance of continuous monitoring of inflammatory markers and imaging. Conclusion: It was concluded that the diagnostic standardization promoted by the Revised Atlanta Classification was fundamental for assertive clinical practice. Early identification of severity criteria enabled the optimization of intensive care support, which positively impacted patient survival and reduced long-term sequelae resulting from acute pancreatitis.