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The 1992 Atlanta Classification (AC) offered the first universally accepted set of definitions for AP (Table 3.1) [9]. AP was defined as an acute inflammatory process of the pancreas that may also involve regional tissue or remote organ systems. Severe AP was broadly defined as the presence of (i) organ failure (shock, pulmonary insufficiency, renal failure, gastrointestinal bleeding) and/or (ii) local complications (especially pancreatic necrosis, but also abscess or pseudocyst). Early predictors of severity included three or more of Ranson’s criteria or an Acute Physiology, Age, and Chronic Health Evaluation (APACHE)‐II score of 8 or more. Additional terms, including mild AP, acute fluid collections, pancreatic necrosis, acute pseudocyst, and pancreatic abscess, were defined.

The AC served as the first clinically based classification system and provided the framework for how AP is defined today. However, some of the definitions proved ambiguous and were used inconsistently, for example (i) a uniform serum lipase and/or amylase threshold for diagnosis was not established; (ii) transient and persistent organ failure were not differentiated; and (iii) a heterogeneous group of patients with varying severity and mortality were combined into a single severe AP category [10]. These limitations led to large variability in the interpretation of organ failure and local complications [10,11].

With better understanding of the pathophysiology of organ failure and pancreatic necrosis, two widely adopted classification systems were subsequently derived: the Revised Atlanta Classification (RAC) and Determinant‐Based Classification (DBC) [12,13].