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Persistent organ failure is the primary determinant of outcomes and accounts for nearly all the mortality in AP [14–16]. Established risk factors include older age, comorbid conditions, obesity, elevated triglyceride levels, and certain etiologies (alcohol) [17–20]. Organ failure according to RAC is defined as a score of 2 or above for at least one of three organ systems using the modified Marshall scoring system (Table 3.2) [21]. Persistent organ failure is defined as organ failure which lasts more than 48 hours while transient organ failure lasts less than 48 hours.

Table 3.1 Comparison of Atlanta Classification, Revised Atlanta Classification, and Determinant‐Based Classification.

Source: adapted from Bradley [9].

Atlanta Classification	Mild	No organ failure and no local complications
Severe	Organ failure and/or local complications
Revised Atlanta Classification	Mild	No organ failure and no local or systemic complications
Moderately severe	Transient organ failure and/or local and/or systemic complications
Severe	Persistent organ failure
Determinant‐Based Classification	Mild	No organ failure and no necrosis
Moderate	Transient organ failure and/or sterile necrosis
Severe	Persistent organ failure or infected necrosis
	Critical	Persistent organ failure and infected necrosis