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Esto significa clasificar la gravedad con precisi&#243;n en cualquier punto del tiempo a lo largo de la evoluci&#243;n de la enfermedad&#44; y no solo al final o como un punto temporal arbitrario&#44; como una semana despu&#233;s de la aparici&#243;n de los s&#237;ntomas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La elaboraci&#243;n de una nueva clasificaci&#243;n de la gravedad de la pancreatitis aguda ha implicado 3 etapas&#46; La primera etapa comenz&#243; con el reconocimiento de las limitaciones de las clasificaciones anteriores&#44; incluida la clasificaci&#243;n de Atlanta&#44; y una amplia revisi&#243;n de la mejor evidencia disponible<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;20</span></a>&#46; Luego fue la introducci&#243;n de nuevas categor&#237;as de gravedad&#44; incluyendo una gravedad &#171;moderada&#187;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;21</span></a> y otra gravedad &#171;cr&#237;tica&#187;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;22&#44;23</span></a>&#44; y la propuesta de la nueva clasificaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La segunda fase consisti&#243; en una encuesta mundial de pancreat&#243;logos expertos basada en la web&#44; para obtener la opini&#243;n sobre las cuestiones controvertidas relacionadas con la clasificaci&#243;n de la gravedad y que no estaban tratadas en la literatura m&#233;dica o permanec&#237;an sin concluir a pesar de las publicaciones<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; La lista de pancreat&#243;logos se gener&#243; mediante la identificaci&#243;n en Medline de los autores correspondientes de todos los art&#237;culos sobre aspectos cl&#237;nicos de la pancreatitis aguda&#44; publicados en los &#250;ltimos 5 a&#241;os &#40;2006 a 2010&#41;&#46; Este enfoque fue adoptado para hacer posible el desarrollo de la nueva clasificaci&#243;n&#44; con la m&#225;xima apertura y transparencia&#58; los pancreat&#243;logos actualmente activos en el campo fueron invitados a participar&#44; sin importar su afiliaci&#243;n con una organizaci&#243;n profesional&#44; pa&#237;s de residencia&#44; idioma de publicaci&#243;n&#44; etc&#46; Se enviaron invitaciones por e-mail a 528 pancreat&#243;logos de 55 pa&#237;ses&#46; Participaron en la encuesta un total de 240 pancreat&#243;logos de 49 pa&#237;ses que representan a todos los continentes&#46; El documento final se desarroll&#243; utilizando los resultados de este estudio&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La tercera etapa fue la convocatoria de un simposio internacional durante el Congreso Mundial 2011 de la Asociaci&#243;n Internacional de Pancreatolog&#237;a &#40;Kochi&#44; India&#41; para discutir m&#225;s a fondo la propuesta de clasificaci&#243;n y buscar un acuerdo sobre las definiciones&#46; Alrededor de 100 participantes asistieron a la reuni&#243;n y contribuyeron a la discusi&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La versi&#243;n completa de la clasificaci&#243;n internacional multidisciplinaria fue publicada en la revista <span class="elsevierStyleItalic">Annals of Surgery</span><a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; El presente documento es la edici&#243;n oficial en espa&#241;ol de la clasificaci&#243;n internacional multidisciplinaria de la PA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Factores determinantes de la gravedad</span><p id="par0035" class="elsevierStylePara elsevierViewall">La clasificaci&#243;n se basa principalmente en los factores que est&#225;n causalmente asociados con la gravedad de la pancreatitis aguda<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Estos factores se denominan &#171;determinantes&#187; y son tanto locales como sist&#233;micos&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Factor determinante local</span><p id="par0040" class="elsevierStylePara elsevierViewall">El factor determinante local de la gravedad es la necrosis del p&#225;ncreas y&#47;o tejido peripancre&#225;tico &#40;en adelante &#171;necrosis &#40;peri&#41; pancre&#225;tica&#187;&#41;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#8211;35</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Necrosis &#40;peri&#41; pancre&#225;tica es el tejido no viable situado en el p&#225;ncreas aislado&#44; en los tejidos del mismo y del &#225;rea peripancre&#225;tica&#44; o solo en los tejidos adyacentes peripancre&#225;ticos&#46; Radiol&#243;gicamente puede ser s&#243;lida o semis&#243;lida &#40;parcialmente licuada&#41;&#44; y sin pared definida<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#8211;39</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Necrosis &#40;peri&#41; pancre&#225;tica est&#233;ril es la ausencia de infecci&#243;n demostrada en la necrosis<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#8211;42</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Necrosis &#40;peri&#41; pancre&#225;tica infectada se define cuando se constata al menos uno de los siguientes signos<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#8211;48</span></a>&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Burbujas de gas en el interior de la necrosis &#40;peri&#41; pancre&#225;tica en la tomograf&#237;a computarizada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Un cultivo positivo de la necrosis &#40;peri&#41; pancre&#225;tica obtenida mediante aspiraci&#243;n con aguja fina y guiada por imagen&#44; o con muestra recogida durante el drenaje y&#47;o necrosectom&#237;a&#46;</p></li></ul></p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Factor determinante sist&#233;mico</span><p id="par0075" class="elsevierStylePara elsevierViewall">El factor determinante sist&#233;mico de gravedad es un cierto grado de disfunci&#243;n de &#243;rganos distantes causado por la pancreatitis aguda&#46; Esto se conoce con el t&#233;rmino &#171;insuficiencia de &#243;rganos&#44; o fallo org&#225;nico&#187;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">La insuficiencia de &#243;rganos&#44; o fallo org&#225;nico&#44; se define para 3 sistemas &#40;cardiovascular&#44; renal y respiratorio&#41; en funci&#243;n de la peor medici&#243;n en un periodo de 24 h&#46; En los pacientes sin disfunci&#243;n org&#225;nica preexistente&#44; el fallo org&#225;nico se define mediante el m&#233;todo SOFA como una puntuaci&#243;n de &#8805; 2 &#40;SOFA en ingl&#233;s&#58; Sepsis-related Organ Failure Assessment&#41;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">49&#8211;51</span></a> o cuando se altera el l&#237;mite superior de la normalidad y que se muestra a continuaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#8211;59</span></a>&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Cardiovascular&#58; necesidad de agente inotr&#243;pico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Renal&#58; creatinina<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171<span class="elsevierStyleHsp" style=""></span>mmol&#47;l &#40;&#61; 2&#44;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Respiratoria&#58; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>300&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Fallo o insuficiencia org&#225;nica persistente es la evidencia de insuficiencia en el mismo &#243;rgano durante 48 h o m&#225;s&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Fallo o insuficiencia org&#225;nica transitoria es la evidencia de insuficiencia en el mismo &#243;rgano durante menos de 48 h&#46;</p></li></ul></p></li></ul></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clasificaci&#243;n de la gravedad</span><p id="par0115" class="elsevierStylePara elsevierViewall">Las categor&#237;as de gravedad de la pancreatitis aguda se definen en funci&#243;n de factores determinantes locales &#40;necrosis &#40;peri&#41; pancre&#225;tica ausente&#44; est&#233;ril o infectada&#41; y al factor determinante sist&#233;mico &#40;insuficiencia org&#225;nica ausente&#44; transitoria o persistente&#41;&#44; as&#237; como la posibilidad de interacci&#243;n entre dichos determinantes durante el mismo episodio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Otros factores distintos a estos determinantes locales y sist&#233;micos de gravedad<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">60&#8211;62</span></a> se deben considerar como otro tipo de complicaciones y no deben ser utilizados para este prop&#243;sito&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">1&#46;</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda leve</span> &#40;PAL&#41; se caracteriza por la ausencia tanto de la necrosis &#40;peri&#41; pancre&#225;tica como de fallo org&#225;nico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">2&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda moderada</span> &#40;PAM&#41; se caracteriza por la presencia de cualquier tipo de necrosis &#40;peri&#41; pancre&#225;tica est&#233;ril o fallo org&#225;nico transitorio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">3&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda grave</span> &#40;PAG&#41; se caracteriza por la presencia de cualquier grado de necrosis &#40;peri&#41; pancre&#225;tica infectada o fallo org&#225;nico persistente&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">4&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda cr&#237;tica</span> &#40;PAC&#41; se caracteriza por la presencia de necrosis &#40;peri&#41; pancre&#225;tica infectada y fallo org&#225;nico persistente&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Hay 2 principios fundamentales sobre los que se fundamenta la nueva clasificaci&#243;n de gravedad&#46; En primer lugar&#44; se basa en factores reales de gravedad en lugar de factores que son predictivos de gravedad&#46; El uso de sistemas de puntuaci&#243;n multifactoriales &#40;por ejemplo&#44; la puntuaci&#243;n APACHE <span class="elsevierStyleSmallCaps">II</span> o los criterios de Ranson&#41; para predecir la gravedad fue incorporada en la clasificaci&#243;n original de Atlanta y&#44; sin duda&#44; fue un importante avance hace 2 d&#233;cadas&#44; cuando todav&#237;a no estaba bien desarrollada la imagen radiol&#243;gica y no se reconoc&#237;a la importancia de la insuficiencia de &#243;rganos en la evoluci&#243;n de una pancreatitis aguda<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&#46; Pero estos sistemas de puntuaci&#243;n est&#225;n plagados de errores a la hora de clasificar la enfermedad&#44; lo cual limita su utilidad en la pr&#225;ctica cl&#237;nica y en la selecci&#243;n de pacientes individuales en los ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">64&#8211;67</span></a>&#46; No obstante lo anterior&#44; la predicci&#243;n de la gravedad sigue siendo un concepto valioso&#44; pero&#44; para mejorar el rendimiento&#44; hay que predecir los factores reales de gravedad &#40;necrosis &#91;peri&#93; pancre&#225;tica y&#47;o insuficiencia de &#243;rganos&#41;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a>&#46; Un ejemplo reciente de ello es la medici&#243;n de la angiopoyetina-2&#44; un marcador del s&#237;ndrome de fuga vascular&#44; en la predicci&#243;n de fallo org&#225;nico persistente<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a>&#46; La identificaci&#243;n de marcadores tempranos de fallo org&#225;nico persistente es importante&#44; porque es una preocupaci&#243;n&#44; especialmente entre los intensivistas&#44; de que los pacientes con pancreatitis aguda a menudo ingresan demasiado tarde en la unidad de cuidados intensivos<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En segundo lugar&#44; la nueva clasificaci&#243;n define la gravedad &#250;nicamente sobre la base de factores que tienen una asociaci&#243;n causal con la gravedad&#46; Basado en el concepto de causa-efecto&#44; estos factores en pacientes con pancreatitis aguda son&#58; la necrosis &#40;peri&#41; pancre&#225;tica y el fracaso de &#243;rganos<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">11</span></a>&#46; Esto contrasta con los intentos emp&#237;ricos que vinculan la gravedad de la pancreatitis aguda con acontecimientos no causales como la hospitalizaci&#243;n prolongada&#44; la necesidad de una intervenci&#243;n y la muerte<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">71&#8211;75</span></a>&#46; La literatura m&#233;dica est&#225; repleta de innumerables estudios que demuestran una asociaci&#243;n estad&#237;sticamente significativa entre una amplia gama de factores y la gravedad de la pancreatitis aguda<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">76&#8211;79</span></a>&#46; Aunque es posible que sean estad&#237;sticamente correctas&#44; vale la pena se&#241;alar que estas asociaciones no son causales&#44; dan lugar a confusi&#243;n y el error m&#225;s com&#250;n es confundir el efecto-causa<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Como tal&#44; estas asociaciones no tienen sentido y pueden incluso inducir a error en la clasificaci&#243;n de la gravedad&#46; Cuando aplicamos estos principios antes mencionados&#44; resultan 4 categor&#237;as de gravedad&#46; Los expertos consultados apoyaban esta clasificaci&#243;n basada en determinantes de gravedad &#40;88&#37; de los encuestados&#41; y se consideran &#250;tiles para la pr&#225;ctica cl&#237;nica &#40;90&#37;&#41; y sobre todo en la investigaci&#243;n &#40;91&#37;&#41;&#44; aunque podr&#237;a ponerse en duda la ventaja sobre otros tipos de clasificaciones anteriores<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; En &#250;ltima instancia&#44; la respuesta a esto se determinar&#225; cuando la nueva clasificaci&#243;n se aplique a los pacientes&#44; se estudie la evoluci&#243;n cl&#237;nica y con la experiencia cl&#237;nica diaria<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#44;81</span></a>&#46; Por ahora&#44; una ventaja cl&#237;nica obvia es que las definiciones son f&#225;ciles de utilizar&#44; est&#225;n normalizadas y no son ambiguas y&#44; como tal&#44; ser&#225;n una ayuda en el seguimiento del curso de la enfermedad y en la comunicaci&#243;n entre los cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; En la investigaci&#243;n cl&#237;nica&#44; la clasificaci&#243;n basada en factores determinantes de gravedad tambi&#233;n ser&#225; &#250;til para la selecci&#243;n m&#225;s homog&#233;nea de pacientes en los ensayos cl&#237;nicos y en la evaluaci&#243;n del efecto de un tratamiento &#40;por ejemplo&#44; como criterio de valoraci&#243;n en los estudios de intervenci&#243;n y su efecto preventivo sobre la gravedad&#41;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;13</span></a>&#46; La distribuci&#243;n de la gravedad es piramidal&#44; lo que significa que probablemente se requieran estudios multic&#233;ntricos de colaboraci&#243;n para estudiar grupos m&#225;s peque&#241;os de categor&#237;a grave y cr&#237;tica&#44; mientras que los estudios de un solo centro puedan ser capaces de estudiar los grupos m&#225;s amplios de gravedad leve y moderada<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0155" class="elsevierStylePara elsevierViewall">Esta consulta internacional multidisciplinaria fue posible gracias a la colaboraci&#243;n activa y constructiva de m&#225;s de 200 cirujanos&#44; gastroenter&#243;logos&#44; internistas&#44; intensivistas y radi&#243;logos de 49 pa&#237;ses que representan a todos los continentes&#46; La clasificaci&#243;n de la gravedad de la pancreatitis aguda contin&#250;a evolucionando&#46; En el futuro ser&#225;n necesarias otras modificaciones&#44; guiadas tras la revisi&#243;n sistem&#225;tica de los nuevos datos que surjan y convocando un nuevo proceso de consulta internacional&#46; Pero en este momento tenemos pruebas suficientes&#44; la opini&#243;n de expertos y la justificaci&#243;n para aplicar en la pr&#225;ctica cl&#237;nica y en la investigaci&#243;n esta clasificaci&#243;n basada en factores determinantes de gravedad de la pancreatitis aguda&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflictos de inter&#233;s</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Desarrollar una nueva clasificaci&#243;n de la gravedad de la pancreatitis aguda sobre la base de un s&#243;lido marco conceptual&#44; la revisi&#243;n exhaustiva de la evidencia publicada&#44; y una consulta en todo el mundo&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las definiciones Atlanta&#8217;92 de la gravedad de la pancreatitis aguda est&#225;n muy arraigadas entre los pancreat&#243;logos&#44; pero con un resultado deficiente debido a que estas definiciones est&#225;n basadas en la descripci&#243;n emp&#237;rica de hechos que no est&#225;n asociadas con la gravedad&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se envi&#243; una invitaci&#243;n personal para contribuir al desarrollo de una nueva clasificaci&#243;n de la gravedad de la pancreatitis aguda a todos los cirujanos&#44; gastroenter&#243;logos&#44; internistas&#44; intensivistas&#44; radi&#243;logos y que actualmente se encuentran activos en el campo de la pancreatitis aguda&#46; La invitaci&#243;n no se limit&#243; a los miembros de determinadas asociaciones o residentes de ciertos pa&#237;ses&#46; Se llev&#243; a cabo una encuesta basada en una web mundial y se organiz&#243; un simposio internacional para que los colaboradores de las diferentes disciplinas se dedicaran a debatir el concepto y definiciones&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La nueva clasificaci&#243;n se basa en los determinantes reales locales y sist&#233;micos de gravedad&#44; en lugar de la descripci&#243;n de los eventos que est&#225;n asociados con la causa de la gravedad&#46; El factor determinante local se refiere a si existe necrosis &#40;peri&#41; pancre&#225;tica o no&#44; y si est&#225; presente&#44; si es est&#233;ril o infectado&#46; El factor determinante sist&#233;mico se refiere a si existe fracaso org&#225;nico o no&#44; y si est&#225; presente&#44; ya sea de forma transitoria o persistente&#46; La presencia de un determinante puede modificar el efecto de otra&#44; de tal manera que la presencia tanto de la necrosis &#40;peri&#41; pancre&#225;tica infectada y el fracaso org&#225;nico persistente tienen un mayor efecto sobre la gravedad que si esas determinantes son &#250;nicas&#46; La clasificaci&#243;n basada en los resultados de los principios anteriores deriva en 4 categor&#237;as de gravedad&#58; leve&#44; moderada&#44; severa y cr&#237;tica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Esta clasificaci&#243;n es el resultado de un proceso de consulta entre pancreat&#243;logos de 49 pa&#237;ses que abarcan Am&#233;rica del Norte&#44; Am&#233;rica del Sur&#44; Europa&#44; Asia&#44; Ocean&#237;a y &#193;frica&#46; Ofrece una puesta al d&#237;a de un conjunto de definiciones concisas&#44; de todas las principales entidades necesarias para clasificar la gravedad de la pancreatitis aguda durante la pr&#225;ctica cl&#237;nica y para su uso en la investigaci&#243;n&#46; Esto asegura que en todo el mundo se pueda utilizar uniformemente la clasificaci&#243;n basada en factores determinantes&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework&#44; comprehensive review of the published evidence&#44; and worldwide consultation&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Backgrounds</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of specialist in pancreatic diseases&#44; but are suboptimal because these definitions are based on the empiric description of events not associated with severity&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons&#44; gastroenterologists&#44; internists&#44; intensivists and radiologists currently active in the field of clinical acute pancreatitis&#46; The invitation was not limited to members of certain associations or residents of certain countries&#46; A global web-based survey was conducted&#44; and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The new classification of severity is based on the actual local and systemic determinants of severity&#44; rather than on the description of events that are non-causally associated with severity&#46; The local determinant relates to whether there is &#40;peri&#41; pancreatic necrosis or not&#44; and if present&#44; whether it is sterile or infected&#46; The systemic determinant relates to whether there is organ failure or not&#44; and if present&#44; whether it is transient or persistent&#46; The presence of one determinant can modify the effect of another&#44; whereby the presence of both infected &#40;peri&#41; pancreatic necrosis and persistent organ failure has a greater impact upon severity than either determinant alone&#46; The derivation of a classification based on the above principles results in four categories of severity&#58; mild&#44; moderate&#44; severe&#44; and critical&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">This classification is the result of a consultative process among specialists in pancreatic diseases from 49 countries spanning North America&#44; South America&#44; Europe&#44; Asia&#44; Oceania and Africa&#46; It provides a set of concise up to date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research&#46; This ensures that the determinant-based classification can be used in a uniform manner throughout the world&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Este manuscrito ha sido publicado previamente en Ann Surg&#46; 2012&#59;256&#58;875-80&#46; doi&#58; 10&#46;1097&#47;SLA&#46;0b013e318256f778 y se tiene el permiso del editor&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">PA moderada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">PA cr&#237;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Necrosis &#40;peri&#41; pancre&#225;tica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Est&#233;ril&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Infectada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">y&#47;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Insuficiencia o fallo org&#225;nico&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n de la pancreatitis aguda basada en factores determinantes de gravedad</p>"
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      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:81 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnosis and treatment of acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Woolsey"
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1903"
                        "volumen" => "38"
                        "paginaInicial" => "726"
                        "paginaFinal" => "735"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17861385"
                            "web" => "Medline"
                          ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pancreatitis&#46; Symposium in Marseille 1963"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Sarles"
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1965"
                        "editorial" => "Karger"
                        "editorialLocalizacion" => "Basel&#44; Switzerland"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Sarner"
                            1 => "P&#46;B&#46; Cotton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "1984"
                        "volumen" => "25"
                        "paginaInicial" => "756"
                        "paginaFinal" => "759"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6735257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised classification of pancreatitis&#46; Report of the Second International Symposium on the Classification of Pancreatitis in Marseille&#44; France&#44; March 28&#46;30&#44; 1984"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;V&#46; Singer"
                            1 => "K&#46; Gyr"
                            2 => "H&#46; Sarles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1985"
                        "volumen" => "89"
                        "paginaInicial" => "683"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4018507"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinically based classification system for acute pancreatitis&#46; Summary of the International Symposium on Acute Pancreatitis&#44; Atlanta&#44; GA&#44; September 11 through 13&#44; 1992"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;L&#46; Bradley III"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "1993"
                        "volumen" => "128"
                        "paginaInicial" => "586"
                        "paginaFinal" => "590"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8489394"
                            "web" => "Medline"
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            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Buter"
                            1 => "C&#46;W&#46; Imrie"
                            2 => "C&#46;R&#46; Carter"
                            3 => "S&#46; Evans"
                            4 => "C&#46;J&#46; McKay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.0007-1323.2001.02025.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2002"
                        "volumen" => "89"
                        "paginaInicial" => "298"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11872053"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;D&#46; Johnson"
                            1 => "M&#46; Abu-Hilal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.2004.039883"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "2004"
                        "volumen" => "53"
                        "paginaInicial" => "1340"
                        "paginaFinal" => "1344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15306596"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between early systemic inflammatory response&#44; severity of multiorgan dysfunction and death in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Mofidi"
                            1 => "M&#46;D&#46; Duff"
                            2 => "S&#46;J&#46; Wigmore"
                            3 => "K&#46;K&#46; Madhavan"
                            4 => "O&#46;J&#46; Garden"
                            5 => "R&#46;W&#46; Parks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.5290"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2006"
                        "volumen" => "93"
                        "paginaInicial" => "738"
                        "paginaFinal" => "744"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16671062"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low mortality and high morbidity in severe acute pancreatitis without organ failure&#58; a case for revising the Atlanta classification to include moderately severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;S&#46; Vege"
                            1 => "T&#46;B&#46; Gardner"
                            2 => "S&#46;T&#46; Chari"
                            3 => "P&#46; Munukuti"
                            4 => "R&#46;K&#46; Pearson"
                            5 => "J&#46;E&#46; Clain"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2008.77"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2009"
                        "volumen" => "104"
                        "paginaInicial" => "710"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19262525"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;S&#46; Petrov"
                            1 => "S&#46; Shanbhag"
                            2 => "M&#46; Chakraborty"
                            3 => "A&#46;R&#46; Phillips"
                            4 => "J&#46;A&#46; Windsor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2010.06.010"
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                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2010"
                        "volumen" => "139"
                        "paginaInicial" => "813"
                        "paginaFinal" => "820"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20540942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0410"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conceptual framework for classifying the severity of acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;S&#46; Petrov"
                            1 => "J&#46;A&#46; Windsor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinre.2012.02.010"
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                        "tituloSerie" => "Clin Res Hepatol Gastroenterol&#46;"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "341"
                        "paginaFinal" => "344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22551642"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Statistical association and causation&#58; contributions of different types of evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;H&#46; Hennekens"
                            1 => "D&#46; DeMets"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2011.322"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2011"
                        "volumen" => "305"
                        "paginaInicial" => "1134"
                        "paginaFinal" => "1135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21406653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Designing future clinical trials in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Mason"
                            1 => "A&#46;K&#46; Siriwardena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000085261"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreatology"
                        "fecha" => "2005"
                        "volumen" => "5"
                        "paginaInicial" => "113"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15849481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infected pancreatic necrosis&#58; not necessarily a late event in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;S&#46; Petrov"
                            1 => "V&#46; Chong"
                            2 => "J&#46;A&#46; Windsor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v17.i27.3173"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "3173"
                        "paginaFinal" => "3176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21912463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice guidelines in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Banks"
                            1 => "M&#46;L&#46; Freeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2006.00856.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2006"
                        "volumen" => "101"
                        "paginaInicial" => "2379"
                        "paginaFinal" => "2400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17032204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Organ failure as an indicator of severity of acute pancreatitis&#58; time to revisit the Atlanta classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;S&#46; Vege"
                            1 => "S&#46;T&#46; Chari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "1133"
                        "paginaFinal" => "1135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15825098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Toward an update of the atlanta classification on acute pancreatitis&#58; review of new and abandoned terms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;L&#46; Bollen"
                            1 => "M&#46;G&#46; Besselink"
                            2 => "H&#46;C&#46; van Santvoort"
                            3 => "H&#46;G&#46; Gooszen"
                            4 => "M&#46;S&#46; van Leewen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/mpa.0b013e31804fa189"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "107"
                        "paginaFinal" => "113"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17632315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AGA Institute technical review on acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;E&#46; Forsmark"
                            1 => "J&#46; Baillie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2007.03.065"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2007"
                        "volumen" => "132"
                        "paginaInicial" => "2022"
                        "paginaFinal" => "2044"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17484894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Sharma"
                            1 => "D&#46; Banerjee"
                            2 => "P&#46;K&#46; Garg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2007.01446.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2007"
                        "volumen" => "102"
                        "paginaInicial" => "2688"
                        "paginaFinal" => "2695"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17662103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revising the Atlanta classification of acute pancreatitis&#58; festina lente"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;S&#46; Petrov"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11605-010-1269-9"
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                        "tituloSerie" => "J Gastrointest Surg"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "paginaInicial" => "1474"
                        "paginaFinal" => "1475"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20585993"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0105"
              "etiqueta" => "21"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Update of the Atlanta classification of severity of acute pancreatitis&#58; should a moderate category be included&#63;"
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                    0 => array:2 [
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                        "tituloSerie" => "Pancreatology"
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                        "volumen" => "10"
                        "paginaInicial" => "613"
                        "paginaFinal" => "619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21042037"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0110"
              "etiqueta" => "22"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Severity stratification of acute pancreatitis&#58; is the new four tier classification useful&#63;"
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                            2 => "T&#46;D&#46; Yadav"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "J Gastroenterol Hepatol"
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                        "paginaInicial" => "229"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0115"
              "etiqueta" => "23"
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                    0 => array:2 [
                      "titulo" => "Prospective application of the four category &#40;mild&#44; moderate&#44; severe&#44; critical&#41; classification of acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "B&#46;I&#46; Babu"
                            2 => "A&#46;K&#46; Siriwardena"
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                    ]
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                        "paginaInicial" => "1339"
                        "paginaFinal" => "1340"
                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of the severity of acute pancreatitis&#58; how many categories make sense&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.597"
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                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "74"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19844203"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global survey of controversies in classifying the severity of acute pancreatitis"
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                            0 => "M&#46;S&#46; Petrov"
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                      ]
                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
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                        "volumen" => "24"
                        "paginaInicial" => "715"
                        "paginaFinal" => "721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22382706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinant-Based Classification of Acute Pancreatitis Severity an International Multidisciplinary Consultation"
                      "autores" => array:1 [
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                          "colaboracion" => "on behalf of the Pancreatitis Across Nations Clinical Research and Education Alliance &#40;PANCREA&#41;"
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                    0 => array:2 [
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                        "tituloSerie" => "Ann Surg"
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                        "paginaInicial" => "875"
                        "paginaFinal" => "880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22735715"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0135"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Acute necrotizing pancreatitis&#58; treatment strategy according to the status of infection"
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                          "etal" => false
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                            5 => "W&#46; Uhl"
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                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Ann Surg"
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                        "paginaInicial" => "619"
                        "paginaFinal" => "626"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11066131"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0140"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2005"
                        "volumen" => "3"
                        "paginaInicial" => "159"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15704050"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early antibiotic treatment for severe acute necrotizing pancreatitis&#58; a randomized&#44; double-blind&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;P&#46; Dellinger"
                            1 => "J&#46;M&#46; Tellado"
                            2 => "N&#46;E&#46; Soto"
                            3 => "S&#46;W&#46; Ashley"
                            4 => "P&#46;S&#46; Barie"
                            5 => "T&#46; Dugernier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.sla.0000250414.09255.84"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "674"
                        "paginaFinal" => "683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17457158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presence and extent of extrapancreatic fluid collections are indicators of severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Lankisch"
                            1 => "K&#46; Struckmann"
                            2 => "D&#46; Lehnick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1385/IJGC:26:3:131"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pancreatol"
                        "fecha" => "1999"
                        "volumen" => "26"
                        "paginaInicial" => "131"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10732289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe acute pancreatitis&#58; nonsurgical treatment of infected necroses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Runzi"
                            1 => "W&#46; Niebel"
                            2 => "H&#46; Goebell"
                            3 => "G&#46; Gerken"
                            4 => "P&#46; Layer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2005"
                        "volumen" => "30"
                        "paginaInicial" => "195"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15782093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Isenmann"
                            1 => "B&#46; Rau"
                            2 => "H&#46;G&#46; Beger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2168.1999.01176.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1999"
                        "volumen" => "86"
                        "paginaInicial" => "1020"
                        "paginaFinal" => "1024"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10460637"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing pancreatitis&#58; contemporary analysis of 99 consecutive cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;W&#46; Ashley"
                            1 => "A&#46; Perez"
                            2 => "E&#46;A&#46; Pierce"
                            3 => "D&#46;C&#46; Brooks"
                            4 => "F&#46;D&#46; Moore Jr&#46;"
                            5 => "E&#46;E&#46; Whang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2001"
                        "volumen" => "234"
                        "paginaInicial" => "572"
                        "paginaFinal" => "579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11573050"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706026453"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; aetiology and outcome of acute and chronic pancreatitis&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;W&#46; Spanier"
                            1 => "M&#46;G&#46; Dijkgraaf"
                            2 => "M&#46;J&#46; Bruno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bpg.2007.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "45"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18206812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Open pancreatic necrosectomy in the multidisciplinary management of postinflammatory necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;I&#46; Babu"
                            1 => "A&#46;J&#46; Sheen"
                            2 => "S&#46;H&#46; Lee"
                            3 => "S&#46; O&#39;Shea"
                            4 => "J&#46;M&#46; Eddleston"
                            5 => "A&#46;K&#46; Siriwardena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e3181b59303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2010"
                        "volumen" => "251"
                        "paginaInicial" => "783"
                        "paginaFinal" => "786"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20195152"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrapancreatic necrotizing pancreatitis with viable pancreas&#58; a previously under-appreciated entity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;H&#46; Sakorafas"
                            1 => "G&#46;G&#46; Tsiotos"
                            2 => "M&#46;G&#46; Sarr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Surg"
                        "fecha" => "1999"
                        "volumen" => "188"
                        "paginaInicial" => "643"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10359357"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis&#58; evaluation of a new scoring system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; de Waele"
                            1 => "L&#46; Delrue"
                            2 => "E&#46;A&#46; Hoste"
                            3 => "M&#46; de Vos"
                            4 => "P&#46; Duyck"
                             …1
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/mpa.0b013e31802d4136"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2007"
                        "volumen" => "34"
                        "paginaInicial" => "185"
                        "paginaFinal" => "190"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome in a large unselected series of patients with acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatogastroenterology"
                        "fecha" => "2009"
                        "volumen" => "56"
                        "paginaInicial" => "871"
                        "paginaFinal" => "876"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An assessment of the severity of interstitial pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cgh.2011.08.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2011"
                        "volumen" => "9"
                        "paginaInicial" => "1098"
                        "paginaFinal" => "1103"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severity prediction in acute pancreatitis&#58; the role of early CT scan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00261-007-9223-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Abdom Imaging"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "265"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice and yield of early CT scan in acute pancreatitis&#58; a Dutch Observational Multicenter Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000243731"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreatology"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "222"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute pancreatitis&#58; assessment of severity with clinical and CT evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2233010680"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2002"
                        "volumen" => "223"
                        "paginaInicial" => "603"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Computerized tomographic fine needle aspiration &#40;CT-FNA&#41; is valuable in the management of infected pancreatic necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2005.00328_1.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2005"
                        "volumen" => "100"
                        "paginaInicial" => "2371"
                        "paginaFinal" => "2372"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute necrotizing pancreatitis&#58; management by planned&#44; staged pancreatic necrosectomy&#47;debridement and delayed primary wound closure over drains"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1991"
                        "volumen" => "78"
                        "paginaInicial" => "576"
                        "paginaFinal" => "581"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673606679336"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does an infected peripancreatic fluid collection or abscess mandate operation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2000"
                        "volumen" => "231"
                        "paginaInicial" => "361"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin &#40;PCT&#41;&#58; a prospective international multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.sla.0000252443.22360.46"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "745"
                        "paginaFinal" => "754"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis&#58; systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surg.2009.02.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgery"
                        "fecha" => "2009"
                        "volumen" => "146"
                        "paginaInicial" => "72"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does serum procalcitonin have a role in evaluating the severity of acute pancreatitis&#63; A question revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00268-006-0167-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "1713"
                        "paginaFinal" => "1721"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The SOFA &#40;Sepsis-related Organ Failure Assessment&#41; score to describe organ dysfunction&#47;failure"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine"
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "1996"
                        "volumen" => "22"
                        "paginaInicial" => "707"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
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                    ]
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                ]
              ]
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            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early severe acute pancreatitis&#58; characteristics of a new subgroup"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2001"
                        "volumen" => "22"
                        "paginaInicial" => "274"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706001574"
                          "estado" => "S300"
                          "issn" => "07351097"
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                  ]
                ]
              ]
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            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and management of patients with early acute severe pancreatitis&#58; experience from a medical center in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2004"
                        "volumen" => "10"
                        "paginaInicial" => "919"
                        "paginaFinal" => "921"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early physiological response to intensive care as a clinically relevant approach to predicting the outcome in severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archsurg.139.4.438"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "2004"
                        "volumen" => "139"
                        "paginaInicial" => "438"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and reversibility of organ failure in the course of sterile or infected necrotizing pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "2001"
                        "volumen" => "136"
                        "paginaInicial" => "1386"
                        "paginaFinal" => "1390"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The study on causes of death in fulminant pancreatitis at early stage and late stage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sichuan Da Xue Xue Bao Yi Xue Ban"
                        "fecha" => "2011"
                        "volumen" => "42"
                        "paginaInicial" => "686"
                        "paginaFinal" => "690"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early management of severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11894-010-0174-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Gastroenterol Rep"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "123"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship of necrosis to organ failure in severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1997"
                        "volumen" => "113"
                        "paginaInicial" => "899"
                        "paginaFinal" => "903"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe acute pancreatitis in China&#58; etiology and mortality in 1976 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPA.0b013e3180654d20"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "232"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple organ dysfunction associated with severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "30"
                        "paginaInicial" => "1274"
                        "paginaFinal" => "1279"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Research Committee of Intractable Diseases of the Pancreas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPA.0b013e318214812b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2011"
                        "volumen" => "40"
                        "paginaInicial" => "503"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Scoring systems in acute pancreatitis&#58; which one to use in intensive care units&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2010"
                        "volumen" => "25"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The performance of organ dysfunction scores for the early prediction and management of severity in acute pancreatitis&#58; an exploratory phase diagnostic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPA.0b013e3181f73b19"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "1104"
                        "paginaFinal" => "1108"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of BISAP&#44; Ranson&#39;s&#44; APACHE-II&#44; and CTSI scores in predicting organ failure&#44; complications&#44; and mortality in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.622"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "435"
                        "paginaFinal" => "441"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based clinical guidelines for acute pancreatitis &#8212;diagnosis of the severity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nihon Naika Gakkai Zasshi"
                        "fecha" => "2004"
                        "volumen" => "93"
                        "paginaInicial" => "10"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of the severity of acute pancreatitis&#58; no room for complacency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000123604"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreatology"
                        "fecha" => "2008"
                        "volumen" => "8"
                        "paginaInicial" => "105"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The difficulty in predicting outcome in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.623"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "443"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181b785a2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "38"
                        "paginaInicial" => "283"
                        "paginaFinal" => "287"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
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                    ]
                  ]
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            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of severity of acute pancreatitis according to new prognostic factors and CT grading"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00534-009-0213-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatobiliary Pancreat Sci"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "37"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
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              "identificador" => "bib0340"
              "etiqueta" => "68"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting the severity of acute pancreatitis&#58; choose the right horse before hitching the cart"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-011-1924-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2011"
                        "volumen" => "56"
                        "paginaInicial" => "3402"
                        "paginaFinal" => "3404"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
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                    ]
                  ]
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              ]
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            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiopoietin-2&#44; a regulator of vascular permeability in inflammation&#44; is associated with persistent organ failure in patients with acute pancreatitis from the United States and Germany"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2010.183"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "2287"
                        "paginaFinal" => "2292"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
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                    ]
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                ]
              ]
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            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotics and severe acute pancreatitis in Intensive Medicine&#46; Current status&#46; Recommendations of the 7<span class="elsevierStyleHsp" style=""></span>th Consensus Conference of the SEMICYUC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Medicina Intensiva"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "78"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109705025829"
                          "estado" => "S300"
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              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New classification of acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ugeskr Laeger"
                        "fecha" => "2011"
                        "volumen" => "173"
                        "paginaInicial" => "42"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of acute pancreatitis&#58; revised Atlanta classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rcl.2012.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiol Clin N Am"
                        "fecha" => "2012"
                        "volumen" => "50"
                        "paginaInicial" => "429"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid collections in and around the pancreas in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
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                          "etal" => false
                          "autores" => array:5 [ …5]
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                          0 => array:2 [ …2]
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                          "etal" => true
                          "autores" => array:6 [ …6]
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                        "volumen" => "95"
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                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk and markers of severe acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
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                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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                          "etal" => true
                          "autores" => array:6 [ …6]
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                        "volumen" => "9"
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                        "paginaFinal" => "614"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
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                        "paginaFinal" => "532"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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                          "etal" => true
                          "autores" => array:6 [ …6]
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                          "etal" => false
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O&#8217;Reilly DA &#40;United Kingdom&#41;&#44; Oria A &#40;Argentina&#41;&#44; Panek J &#40;Poland&#41;&#44; Papachristou GI &#40;United States&#41;&#44; Parekh D &#40;United States&#41;&#44; Parks RW &#40;United Kingdom&#41;&#44; Passaglia C &#40;Italy&#41;&#44; Pearce CB &#40;Australia&#41;&#44; Pellegrini D &#40;Argentina&#41;&#44; Perez-Mateo M &#40;Spain&#41;&#44; Petrov MS &#40;New Zealand&#41;&#44; Pettila <span class="elsevierStyleSmallCaps">V</span> &#40;Finland&#41;&#44; Pezzilli R &#40;Italy&#41;&#44; Pitchumoni CS &#40;United States&#41;&#44; Pongprasobchai S &#40;Thailand&#41;&#44; Poves Prim <span class="elsevierStyleSmallCaps">I</span> &#40;Spain&#41;&#44; Puolakkainen P &#40;Finland&#41;&#44; Pupelis G &#40;Latvia&#41;&#44; Radenkovic DV &#40;Serbia&#41;&#44; Rahman SH &#40;United Kingdom&#41;&#44; Rau B &#40;Germany&#41;&#44; Regidor Sanz E &#40;Spain&#41;&#44; Repiso A &#40;Spain&#41;&#44; Rodrigo L &#40;Spain&#41;&#44; Rydzewska G &#40;Poland&#41;&#44; S&#225;nchez-Izquierdo Riera JA &#40;Spain&#41;&#44; Savides TJ &#40;United States&#41;&#44; Scaglione M &#40;Italy&#41;&#44; Serrablo A &#40;Spain&#41;&#44; Servin-Torres E &#40;Mexico&#41;&#44; Sethu <span class="elsevierStyleSmallCaps">I</span> &#40;India&#41;&#44; Sezgin O &#40;Turkey&#41;&#44; Shankar-Hari M &#40;United Kingdom&#41;&#44; Shimosegawa T &#40;Japan&#41;&#44; Singer MV &#40;United Kingdom&#41;&#44; Sinha SK &#40;India&#41;&#44; Siriwardena AK &#40;United Kingdom&#41;&#44; Sjoberg Bexelius T &#40;Sweden&#41;&#44; Skipworth JR &#40;United Kingdom&#41;&#44; Soriano FG &#40;Brazil&#41;&#44; Sotoudehmanesh R &#40;Iran&#41;&#44; Spanier BW &#40;Netherlands&#41;&#44; Stabuc B &#40;Slovenia&#41;&#44; Stroescu C &#40;Romania&#41;&#44; Szentkereszty Z &#40;Hungary&#41;&#44; Takacs T &#40;Hungary&#41;&#44; Takada T &#40;Japan&#41;&#44; Takeda K &#40;Japan&#41;&#44; Takeyama Y &#40;Japan&#41;&#44; Talukdar R &#40;India&#41;&#44; Tang W &#40;China&#41;&#44; Tanjoh K &#40;Japan&#41;&#44; Tarnasky PR &#40;United States&#41;&#44; Teich N &#40;Germany&#41;&#44; Tellado JM &#40;Spain&#41;&#44; Tenner S &#40;United States&#41;&#44; Thomson A &#40;Australia&#41;&#44; Tireli M &#40;Turkey&#41;&#44; Tong Z &#40;China&#41;&#44; Triantopoulou C &#40;Greece&#41;&#44; Uomo G &#40;Italy&#41;&#44; Uy MC &#40;Philippines&#41;&#44; van Geenen EJ &#40;Netherlands&#41;&#44; Vege SS &#40;United States&#41;&#44; Velasco Guardado A &#40;Spain&#41;&#44; Vettoretto N &#40;Italy&#41;&#44; Wada K &#40;Japan&#41;&#44; Warshaw AL &#40;United States&#41;&#44; Whitcomb DC &#40;United States&#41;&#44; Wilson JS &#40;Australia&#41;&#44; Windsor JA &#40;New Zealand&#41;&#44; Wittau M &#40;Germany&#41;&#44; Wu BU &#40;United States&#41;&#44; Wysocki AP &#40;Australia&#41;&#44; Yan Quiros E &#40;Peru&#41;&#44; Yasuda T &#40;Japan&#41;&#44; Yu C &#40;China&#41;&#44; Zerem E &#40;Bosnia and Herzegovina&#41;&#44; Zhou <span class="elsevierStyleSmallCaps">X</span> &#40;China&#41;&#44; Zubia Olazcoaga F &#40;Spain&#41;&#44; Zyromski NJ &#40;United States&#41;&#46;</p> <p id="par0180" class="elsevierStylePara elsevierViewall">Agradecimientos al Dr&#46; Felix Zubia por su colaboraci&#243;n en la traducci&#243;n y revisi&#243;n de este documento&#46;</p>"
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Original
Clasificación Internacional y Multidisciplinaria de la Pancreatitis Aguda: Edición española 2013
International Multidisciplinary Classification of Acute Pancreatitis Severity: The 2013 Spanish Edition
E. Maraví-Pomaa,
Autor para correspondencia
, E. Patchen Dellingerb, C.E. Forsmarkc, P. Layerd, P. Lévye, T. Shimosegawaf, A.K. Siriwardenag, G. Uomoh, D.C. Whitcombi, J.A. Windsorj, M.S. Petrovj, Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA)
a UCI-B, Complejo Hospitalario de Navarra (antiguo Hospital Virgen del Camino), Pamplona, España
b Department of Surgery, University of Washington School of Medicine, Seattle, Estados Unidos
c Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Estados Unidos
d Department of Internal Medicine, Israelitic Hospital, Hamburgo, Alemania
e Pôle des Maladies de l’Appareil Digestif, Service de Gastroenterologie-Pancreatologie, Hopital Beaujon, Clichy, Francia
f Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japón
g Department of Surgery, Manchester Royal Infirmary, University of Manchester, Manchester, Reino Unido
h Department of Internal Medicine, Cardarelli Hospital, Nápoles, Italia
i Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Department of Cell Biology and Molecular Physiology, Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, Estados Unidos
j Department of Surgery, University of Auckland, Miembro International Association of Pancreatology, Auckland, Nueva Zelanda
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y que tienen diferente evoluci&#243;n&#46; Este sistema de clasificaci&#243;n debe basarse en los mejores datos disponibles y con una definici&#243;n clara&#44; s&#243;lida y uniforme&#46; Tambi&#233;n es importante que la clasificaci&#243;n de la gravedad se base en factores clave&#44; que tengan una relaci&#243;n causal asociada a la gravedad &#40;es decir&#44; causas reales de mortalidad&#41;&#44; m&#225;s que en la descripci&#243;n de acontecimientos que pueden correlacionarse con la gravedad&#44; pero que no son causa &#40;por ejemplo&#44; hospitalizaci&#243;n prolongada&#41;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Teniendo en cuenta que la pancreatitis aguda evoluciona con el tiempo y que&#44; a nivel de un paciente individual los acontecimientos cl&#237;nicos pueden ocurrir en cualquier momento de cualquier d&#237;a&#44; una clasificaci&#243;n de gravedad deber&#237;a identificar signos claves cada vez que se producen e independientemente del momento en que ocurren<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Esto significa clasificar la gravedad con precisi&#243;n en cualquier punto del tiempo a lo largo de la evoluci&#243;n de la enfermedad&#44; y no solo al final o como un punto temporal arbitrario&#44; como una semana despu&#233;s de la aparici&#243;n de los s&#237;ntomas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La elaboraci&#243;n de una nueva clasificaci&#243;n de la gravedad de la pancreatitis aguda ha implicado 3 etapas&#46; La primera etapa comenz&#243; con el reconocimiento de las limitaciones de las clasificaciones anteriores&#44; incluida la clasificaci&#243;n de Atlanta&#44; y una amplia revisi&#243;n de la mejor evidencia disponible<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;20</span></a>&#46; Luego fue la introducci&#243;n de nuevas categor&#237;as de gravedad&#44; incluyendo una gravedad &#171;moderada&#187;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;21</span></a> y otra gravedad &#171;cr&#237;tica&#187;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;22&#44;23</span></a>&#44; 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con la m&#225;xima apertura y transparencia&#58; los pancreat&#243;logos actualmente activos en el campo fueron invitados a participar&#44; sin importar su afiliaci&#243;n con una organizaci&#243;n profesional&#44; pa&#237;s de residencia&#44; idioma de publicaci&#243;n&#44; etc&#46; Se enviaron invitaciones por e-mail a 528 pancreat&#243;logos de 55 pa&#237;ses&#46; Participaron en la encuesta un total de 240 pancreat&#243;logos de 49 pa&#237;ses que representan a todos los continentes&#46; El documento final se desarroll&#243; utilizando los resultados de este estudio&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La tercera etapa fue la convocatoria de un simposio internacional durante el Congreso Mundial 2011 de la Asociaci&#243;n Internacional de Pancreatolog&#237;a &#40;Kochi&#44; India&#41; para discutir m&#225;s a fondo la propuesta de clasificaci&#243;n y buscar un acuerdo sobre las definiciones&#46; Alrededor de 100 participantes asistieron a la reuni&#243;n y contribuyeron a la discusi&#243;n&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La versi&#243;n completa de la clasificaci&#243;n internacional multidisciplinaria fue publicada en la revista <span class="elsevierStyleItalic">Annals of Surgery</span><a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; El presente documento es la edici&#243;n oficial en espa&#241;ol de la clasificaci&#243;n internacional multidisciplinaria de la PA&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Factores determinantes de la gravedad</span><p id="par0035" class="elsevierStylePara elsevierViewall">La clasificaci&#243;n se basa principalmente en los factores que est&#225;n causalmente asociados con la gravedad de la pancreatitis aguda<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Estos factores se denominan &#171;determinantes&#187; y son tanto locales como sist&#233;micos&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Factor determinante local</span><p id="par0040" class="elsevierStylePara elsevierViewall">El factor determinante local de la gravedad es la necrosis del p&#225;ncreas y&#47;o tejido peripancre&#225;tico &#40;en adelante &#171;necrosis &#40;peri&#41; pancre&#225;tica&#187;&#41;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#8211;35</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Necrosis &#40;peri&#41; pancre&#225;tica es el tejido no viable situado en el p&#225;ncreas aislado&#44; en los tejidos del mismo y del &#225;rea peripancre&#225;tica&#44; o solo en los tejidos adyacentes peripancre&#225;ticos&#46; Radiol&#243;gicamente puede ser s&#243;lida o semis&#243;lida &#40;parcialmente licuada&#41;&#44; y sin pared definida<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#8211;39</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Necrosis &#40;peri&#41; pancre&#225;tica est&#233;ril es la ausencia de infecci&#243;n demostrada en la necrosis<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#8211;42</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Necrosis &#40;peri&#41; pancre&#225;tica infectada se define cuando se constata al menos uno de los siguientes signos<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#8211;48</span></a>&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Burbujas de gas en el interior de la necrosis &#40;peri&#41; pancre&#225;tica en la tomograf&#237;a computarizada&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Un cultivo positivo de la necrosis &#40;peri&#41; pancre&#225;tica obtenida mediante aspiraci&#243;n con aguja fina y guiada por imagen&#44; o con muestra recogida durante el drenaje y&#47;o necrosectom&#237;a&#46;</p></li></ul></p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Factor determinante sist&#233;mico</span><p id="par0075" class="elsevierStylePara elsevierViewall">El factor determinante sist&#233;mico de gravedad es un cierto grado de disfunci&#243;n de &#243;rganos distantes causado por la pancreatitis aguda&#46; Esto se conoce con el t&#233;rmino &#171;insuficiencia de &#243;rganos&#44; o fallo org&#225;nico&#187;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">La insuficiencia de &#243;rganos&#44; o fallo org&#225;nico&#44; se define para 3 sistemas &#40;cardiovascular&#44; renal y respiratorio&#41; en funci&#243;n de la peor medici&#243;n en un periodo de 24 h&#46; En los pacientes sin disfunci&#243;n org&#225;nica preexistente&#44; el fallo org&#225;nico se define mediante el m&#233;todo SOFA como una puntuaci&#243;n de &#8805; 2 &#40;SOFA en ingl&#233;s&#58; Sepsis-related Organ Failure Assessment&#41;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">49&#8211;51</span></a> o cuando se altera el l&#237;mite superior de la normalidad y que se muestra a continuaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#8211;59</span></a>&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Cardiovascular&#58; necesidad de agente inotr&#243;pico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Renal&#58; creatinina<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171<span class="elsevierStyleHsp" style=""></span>mmol&#47;l &#40;&#61; 2&#44;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Respiratoria&#58; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>300&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Fallo o insuficiencia org&#225;nica persistente es la evidencia de insuficiencia en el mismo &#243;rgano durante 48 h o m&#225;s&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Fallo o insuficiencia org&#225;nica transitoria es la evidencia de insuficiencia en el mismo &#243;rgano durante menos de 48 h&#46;</p></li></ul></p></li></ul></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clasificaci&#243;n de la gravedad</span><p id="par0115" class="elsevierStylePara elsevierViewall">Las categor&#237;as de gravedad de la pancreatitis aguda se definen en funci&#243;n de factores determinantes locales &#40;necrosis &#40;peri&#41; pancre&#225;tica ausente&#44; est&#233;ril o infectada&#41; y al factor determinante sist&#233;mico &#40;insuficiencia org&#225;nica ausente&#44; transitoria o persistente&#41;&#44; as&#237; como la posibilidad de interacci&#243;n entre dichos determinantes durante el mismo episodio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Otros factores distintos a estos determinantes locales y sist&#233;micos de gravedad<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">60&#8211;62</span></a> se deben considerar como otro tipo de complicaciones y no deben ser utilizados para este prop&#243;sito&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Definiciones&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">1&#46;</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda leve</span> &#40;PAL&#41; se caracteriza por la ausencia tanto de la necrosis &#40;peri&#41; pancre&#225;tica como de fallo org&#225;nico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">2&#46;</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda moderada</span> &#40;PAM&#41; se caracteriza por la presencia de cualquier tipo de necrosis &#40;peri&#41; pancre&#225;tica est&#233;ril o fallo org&#225;nico transitorio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">3&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda grave</span> &#40;PAG&#41; se caracteriza por la presencia de cualquier grado de necrosis &#40;peri&#41; pancre&#225;tica infectada o fallo org&#225;nico persistente&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">4&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pancreatitis aguda cr&#237;tica</span> &#40;PAC&#41; se caracteriza por la presencia de necrosis &#40;peri&#41; pancre&#225;tica infectada y fallo org&#225;nico persistente&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Hay 2 principios fundamentales sobre los que se fundamenta la nueva clasificaci&#243;n de gravedad&#46; En primer lugar&#44; se basa en factores reales de gravedad en lugar de factores que son predictivos de gravedad&#46; El uso de sistemas de puntuaci&#243;n multifactoriales &#40;por ejemplo&#44; la puntuaci&#243;n APACHE <span class="elsevierStyleSmallCaps">II</span> o los criterios de Ranson&#41; para predecir la gravedad fue incorporada en la clasificaci&#243;n original de Atlanta y&#44; sin duda&#44; fue un importante avance hace 2 d&#233;cadas&#44; cuando todav&#237;a no estaba bien desarrollada la imagen radiol&#243;gica y no se reconoc&#237;a la importancia de la insuficiencia de &#243;rganos en la evoluci&#243;n de una pancreatitis aguda<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&#46; Pero estos sistemas de puntuaci&#243;n est&#225;n plagados de errores a la hora de clasificar la enfermedad&#44; lo cual limita su utilidad en la pr&#225;ctica cl&#237;nica y en la selecci&#243;n de pacientes individuales en los ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">64&#8211;67</span></a>&#46; No obstante lo anterior&#44; la predicci&#243;n de la gravedad sigue siendo un concepto valioso&#44; pero&#44; para mejorar el rendimiento&#44; hay que predecir los factores reales de gravedad &#40;necrosis &#91;peri&#93; pancre&#225;tica y&#47;o insuficiencia de &#243;rganos&#41;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a>&#46; Un ejemplo reciente de ello es la medici&#243;n de la angiopoyetina-2&#44; un marcador del s&#237;ndrome de fuga vascular&#44; en la predicci&#243;n de fallo org&#225;nico persistente<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a>&#46; La identificaci&#243;n de marcadores tempranos de fallo org&#225;nico persistente es importante&#44; porque es una preocupaci&#243;n&#44; especialmente entre los intensivistas&#44; de que los pacientes con pancreatitis aguda a menudo ingresan demasiado tarde en la unidad de cuidados intensivos<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En segundo lugar&#44; la nueva clasificaci&#243;n define la gravedad &#250;nicamente sobre la base de factores que tienen una asociaci&#243;n causal con la gravedad&#46; Basado en el concepto de causa-efecto&#44; estos factores en pacientes con pancreatitis aguda son&#58; la necrosis &#40;peri&#41; pancre&#225;tica y el fracaso de &#243;rganos<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">11</span></a>&#46; Esto contrasta con los intentos emp&#237;ricos que vinculan la gravedad de la pancreatitis aguda con acontecimientos no causales como la hospitalizaci&#243;n prolongada&#44; la necesidad de una intervenci&#243;n y la muerte<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">71&#8211;75</span></a>&#46; La literatura m&#233;dica est&#225; repleta de innumerables estudios que demuestran una asociaci&#243;n estad&#237;sticamente significativa entre una amplia gama de factores y la gravedad de la pancreatitis aguda<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">76&#8211;79</span></a>&#46; Aunque es posible que sean estad&#237;sticamente correctas&#44; vale la pena se&#241;alar que estas asociaciones no son causales&#44; dan lugar a confusi&#243;n y el error m&#225;s com&#250;n es confundir el efecto-causa<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Como tal&#44; estas asociaciones no tienen sentido y pueden incluso inducir a error en la clasificaci&#243;n de la gravedad&#46; Cuando aplicamos estos principios antes mencionados&#44; resultan 4 categor&#237;as de gravedad&#46; Los expertos consultados apoyaban esta clasificaci&#243;n basada en determinantes de gravedad &#40;88&#37; de los encuestados&#41; y se consideran &#250;tiles para la pr&#225;ctica cl&#237;nica &#40;90&#37;&#41; y sobre todo en la investigaci&#243;n &#40;91&#37;&#41;&#44; aunque podr&#237;a ponerse en duda la ventaja sobre otros tipos de clasificaciones anteriores<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; En &#250;ltima instancia&#44; la respuesta a esto se determinar&#225; cuando la nueva clasificaci&#243;n se aplique a los pacientes&#44; se estudie la evoluci&#243;n cl&#237;nica y con la experiencia cl&#237;nica diaria<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#44;81</span></a>&#46; Por ahora&#44; una ventaja cl&#237;nica obvia es que las definiciones son f&#225;ciles de utilizar&#44; est&#225;n normalizadas y no son ambiguas y&#44; como tal&#44; ser&#225;n una ayuda en el seguimiento del curso de la enfermedad y en la comunicaci&#243;n entre los cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; En la investigaci&#243;n cl&#237;nica&#44; la clasificaci&#243;n basada en factores determinantes de gravedad tambi&#233;n ser&#225; &#250;til para la selecci&#243;n m&#225;s homog&#233;nea de pacientes en los ensayos cl&#237;nicos y en la evaluaci&#243;n del efecto de un tratamiento &#40;por ejemplo&#44; como criterio de valoraci&#243;n en los estudios de intervenci&#243;n y su efecto preventivo sobre la gravedad&#41;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">11&#44;13</span></a>&#46; La distribuci&#243;n de la gravedad es piramidal&#44; lo que significa que probablemente se requieran estudios multic&#233;ntricos de colaboraci&#243;n para estudiar grupos m&#225;s peque&#241;os de categor&#237;a grave y cr&#237;tica&#44; mientras que los estudios de un solo centro puedan ser capaces de estudiar los grupos m&#225;s amplios de gravedad leve y moderada<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0155" class="elsevierStylePara elsevierViewall">Esta consulta internacional multidisciplinaria fue posible gracias a la colaboraci&#243;n activa y constructiva de m&#225;s de 200 cirujanos&#44; gastroenter&#243;logos&#44; internistas&#44; intensivistas y radi&#243;logos de 49 pa&#237;ses que representan a todos los continentes&#46; La clasificaci&#243;n de la gravedad de la pancreatitis aguda contin&#250;a evolucionando&#46; En el futuro ser&#225;n necesarias otras modificaciones&#44; guiadas tras la revisi&#243;n sistem&#225;tica de los nuevos datos que surjan y convocando un nuevo proceso de consulta internacional&#46; Pero en este momento tenemos pruebas suficientes&#44; la opini&#243;n de expertos y la justificaci&#243;n para aplicar en la pr&#225;ctica cl&#237;nica y en la investigaci&#243;n esta clasificaci&#243;n basada en factores determinantes de gravedad de la pancreatitis aguda&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflictos de inter&#233;s</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            1 => "Clasificaci&#243;n"
            2 => "Gravedad"
            3 => "Fracaso org&#225;nico"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Desarrollar una nueva clasificaci&#243;n de la gravedad de la pancreatitis aguda sobre la base de un s&#243;lido marco conceptual&#44; la revisi&#243;n exhaustiva de la evidencia publicada&#44; y una consulta en todo el mundo&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las definiciones Atlanta&#8217;92 de la gravedad de la pancreatitis aguda est&#225;n muy arraigadas entre los pancreat&#243;logos&#44; pero con un resultado deficiente debido a que estas definiciones est&#225;n basadas en la descripci&#243;n emp&#237;rica de hechos que no est&#225;n asociadas con la gravedad&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se envi&#243; una invitaci&#243;n personal para contribuir al desarrollo de una nueva clasificaci&#243;n de la gravedad de la pancreatitis aguda a todos los cirujanos&#44; gastroenter&#243;logos&#44; internistas&#44; intensivistas&#44; radi&#243;logos y que actualmente se encuentran activos en el campo de la pancreatitis aguda&#46; La invitaci&#243;n no se limit&#243; a los miembros de determinadas asociaciones o residentes de ciertos pa&#237;ses&#46; Se llev&#243; a cabo una encuesta basada en una web mundial y se organiz&#243; un simposio internacional para que los colaboradores de las diferentes disciplinas se dedicaran a debatir el concepto y definiciones&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La nueva clasificaci&#243;n se basa en los determinantes reales locales y sist&#233;micos de gravedad&#44; en lugar de la descripci&#243;n de los eventos que est&#225;n asociados con la causa de la gravedad&#46; El factor determinante local se refiere a si existe necrosis &#40;peri&#41; pancre&#225;tica o no&#44; y si est&#225; presente&#44; si es est&#233;ril o infectado&#46; El factor determinante sist&#233;mico se refiere a si existe fracaso org&#225;nico o no&#44; y si est&#225; presente&#44; ya sea de forma transitoria o persistente&#46; La presencia de un determinante puede modificar el efecto de otra&#44; de tal manera que la presencia tanto de la necrosis &#40;peri&#41; pancre&#225;tica infectada y el fracaso org&#225;nico persistente tienen un mayor efecto sobre la gravedad que si esas determinantes son &#250;nicas&#46; La clasificaci&#243;n basada en los resultados de los principios anteriores deriva en 4 categor&#237;as de gravedad&#58; leve&#44; moderada&#44; severa y cr&#237;tica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Esta clasificaci&#243;n es el resultado de un proceso de consulta entre pancreat&#243;logos de 49 pa&#237;ses que abarcan Am&#233;rica del Norte&#44; Am&#233;rica del Sur&#44; Europa&#44; Asia&#44; Ocean&#237;a y &#193;frica&#46; Ofrece una puesta al d&#237;a de un conjunto de definiciones concisas&#44; de todas las principales entidades necesarias para clasificar la gravedad de la pancreatitis aguda durante la pr&#225;ctica cl&#237;nica y para su uso en la investigaci&#243;n&#46; Esto asegura que en todo el mundo se pueda utilizar uniformemente la clasificaci&#243;n basada en factores determinantes&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework&#44; comprehensive review of the published evidence&#44; and worldwide consultation&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Backgrounds</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of specialist in pancreatic diseases&#44; but are suboptimal because these definitions are based on the empiric description of events not associated with severity&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons&#44; gastroenterologists&#44; internists&#44; intensivists and radiologists currently active in the field of clinical acute pancreatitis&#46; The invitation was not limited to members of certain associations or residents of certain countries&#46; A global web-based survey was conducted&#44; and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The new classification of severity is based on the actual local and systemic determinants of severity&#44; rather than on the description of events that are non-causally associated with severity&#46; The local determinant relates to whether there is &#40;peri&#41; pancreatic necrosis or not&#44; and if present&#44; whether it is sterile or infected&#46; The systemic determinant relates to whether there is organ failure or not&#44; and if present&#44; whether it is transient or persistent&#46; The presence of one determinant can modify the effect of another&#44; whereby the presence of both infected &#40;peri&#41; pancreatic necrosis and persistent organ failure has a greater impact upon severity than either determinant alone&#46; The derivation of a classification based on the above principles results in four categories of severity&#58; mild&#44; moderate&#44; severe&#44; and critical&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">This classification is the result of a consultative process among specialists in pancreatic diseases from 49 countries spanning North America&#44; South America&#44; Europe&#44; Asia&#44; Oceania and Africa&#46; It provides a set of concise up to date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research&#46; This ensures that the determinant-based classification can be used in a uniform manner throughout the world&#46;</p>"
      ]
    ]
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Este manuscrito ha sido publicado previamente en Ann Surg&#46; 2012&#59;256&#58;875-80&#46; doi&#58; 10&#46;1097&#47;SLA&#46;0b013e318256f778 y se tiene el permiso del editor&#46;</p>"
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                  \t\t\t\t">Est&#233;ril&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Infectada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Infectada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">y&#47;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Insuficiencia o fallo org&#225;nico&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n de la pancreatitis aguda basada en factores determinantes de gravedad</p>"
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                      "titulo" => "The diagnosis and treatment of acute pancreatitis"
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                          "autores" => array:1 [
                            0 => "G&#46; Woolsey"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1903"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17861385"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pancreatitis&#46; Symposium in Marseille 1963"
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                          "autores" => array:1 [
                            0 => "H&#46; Sarles"
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                    0 => array:1 [
                      "Libro" => array:3 [
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                        "editorial" => "Karger"
                        "editorialLocalizacion" => "Basel&#44; Switzerland"
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                  ]
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Sarner"
                            1 => "P&#46;B&#46; Cotton"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "1984"
                        "volumen" => "25"
                        "paginaInicial" => "756"
                        "paginaFinal" => "759"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6735257"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised classification of pancreatitis&#46; Report of the Second International Symposium on the Classification of Pancreatitis in Marseille&#44; France&#44; March 28&#46;30&#44; 1984"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;V&#46; Singer"
                            1 => "K&#46; Gyr"
                            2 => "H&#46; Sarles"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1985"
                        "volumen" => "89"
                        "paginaInicial" => "683"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4018507"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "A clinically based classification system for acute pancreatitis&#46; Summary of the International Symposium on Acute Pancreatitis&#44; Atlanta&#44; GA&#44; September 11 through 13&#44; 1992"
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                        0 => array:2 [
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                          "autores" => array:1 [
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                    0 => array:1 [
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                        "tituloSerie" => "Arch Surg"
                        "fecha" => "1993"
                        "volumen" => "128"
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                        "paginaFinal" => "590"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8489394"
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                    0 => array:2 [
                      "titulo" => "Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Buter"
                            1 => "C&#46;W&#46; Imrie"
                            2 => "C&#46;R&#46; Carter"
                            3 => "S&#46; Evans"
                            4 => "C&#46;J&#46; McKay"
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                    0 => array:2 [
                      "doi" => "10.1046/j.0007-1323.2001.02025.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2002"
                        "volumen" => "89"
                        "paginaInicial" => "298"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11872053"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;D&#46; Johnson"
                            1 => "M&#46; Abu-Hilal"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.2004.039883"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "2004"
                        "volumen" => "53"
                        "paginaInicial" => "1340"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15306596"
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                    0 => array:2 [
                      "titulo" => "Association between early systemic inflammatory response&#44; severity of multiorgan dysfunction and death in acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Mofidi"
                            1 => "M&#46;D&#46; Duff"
                            2 => "S&#46;J&#46; Wigmore"
                            3 => "K&#46;K&#46; Madhavan"
                            4 => "O&#46;J&#46; Garden"
                            5 => "R&#46;W&#46; Parks"
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                    0 => array:2 [
                      "doi" => "10.1002/bjs.5290"
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                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2006"
                        "volumen" => "93"
                        "paginaInicial" => "738"
                        "paginaFinal" => "744"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16671062"
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                      "titulo" => "Low mortality and high morbidity in severe acute pancreatitis without organ failure&#58; a case for revising the Atlanta classification to include moderately severe acute pancreatitis"
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "S&#46;T&#46; Chari"
                            3 => "P&#46; Munukuti"
                            4 => "R&#46;K&#46; Pearson"
                            5 => "J&#46;E&#46; Clain"
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                    0 => array:2 [
                      "doi" => "10.1038/ajg.2008.77"
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                        "tituloSerie" => "Am J Gastroenterol"
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                        "paginaInicial" => "710"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19262525"
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                      "titulo" => "Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;S&#46; Petrov"
                            1 => "S&#46; Shanbhag"
                            2 => "M&#46; Chakraborty"
                            3 => "A&#46;R&#46; Phillips"
                            4 => "J&#46;A&#46; Windsor"
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                      "doi" => "10.1053/j.gastro.2010.06.010"
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                        "tituloSerie" => "Gastroenterology"
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                        "paginaInicial" => "813"
                        "paginaFinal" => "820"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20540942"
                            "web" => "Medline"
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                      ]
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                  ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conceptual framework for classifying the severity of acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;S&#46; Petrov"
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                        ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.clinre.2012.02.010"
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                        "tituloSerie" => "Clin Res Hepatol Gastroenterol&#46;"
                        "fecha" => "2012"
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                        "paginaInicial" => "341"
                        "paginaFinal" => "344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22551642"
                            "web" => "Medline"
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                      ]
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                  ]
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Statistical association and causation&#58; contributions of different types of evidence"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;H&#46; Hennekens"
                            1 => "D&#46; DeMets"
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                    0 => array:2 [
                      "doi" => "10.1001/jama.2011.322"
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                        "tituloSerie" => "JAMA"
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                        "paginaInicial" => "1134"
                        "paginaFinal" => "1135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21406653"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0065"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Designing future clinical trials in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Mason"
                            1 => "A&#46;K&#46; Siriwardena"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000085261"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreatology"
                        "fecha" => "2005"
                        "volumen" => "5"
                        "paginaInicial" => "113"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15849481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infected pancreatic necrosis&#58; not necessarily a late event in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;S&#46; Petrov"
                            1 => "V&#46; Chong"
                            2 => "J&#46;A&#46; Windsor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v17.i27.3173"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "3173"
                        "paginaFinal" => "3176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21912463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice guidelines in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Banks"
                            1 => "M&#46;L&#46; Freeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2006.00856.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2006"
                        "volumen" => "101"
                        "paginaInicial" => "2379"
                        "paginaFinal" => "2400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17032204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Organ failure as an indicator of severity of acute pancreatitis&#58; time to revisit the Atlanta classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;S&#46; Vege"
                            1 => "S&#46;T&#46; Chari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
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                        "volumen" => "128"
                        "paginaInicial" => "1133"
                        "paginaFinal" => "1135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15825098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Toward an update of the atlanta classification on acute pancreatitis&#58; review of new and abandoned terms"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;L&#46; Bollen"
                            1 => "M&#46;G&#46; Besselink"
                            2 => "H&#46;C&#46; van Santvoort"
                            3 => "H&#46;G&#46; Gooszen"
                            4 => "M&#46;S&#46; van Leewen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/mpa.0b013e31804fa189"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "107"
                        "paginaFinal" => "113"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17632315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AGA Institute technical review on acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;E&#46; Forsmark"
                            1 => "J&#46; Baillie"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2007.03.065"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2007"
                        "volumen" => "132"
                        "paginaInicial" => "2022"
                        "paginaFinal" => "2044"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17484894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Sharma"
                            1 => "D&#46; Banerjee"
                            2 => "P&#46;K&#46; Garg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2007.01446.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2007"
                        "volumen" => "102"
                        "paginaInicial" => "2688"
                        "paginaFinal" => "2695"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17662103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revising the Atlanta classification of acute pancreatitis&#58; festina lente"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;S&#46; Petrov"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11605-010-1269-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastrointest Surg"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "paginaInicial" => "1474"
                        "paginaFinal" => "1475"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20585993"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0105"
              "etiqueta" => "21"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Update of the Atlanta classification of severity of acute pancreatitis&#58; should a moderate category be included&#63;"
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                          "etal" => true
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                    0 => array:2 [
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                        "tituloSerie" => "Pancreatology"
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                        "volumen" => "10"
                        "paginaInicial" => "613"
                        "paginaFinal" => "619"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21042037"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0110"
              "etiqueta" => "22"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Severity stratification of acute pancreatitis&#58; is the new four tier classification useful&#63;"
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                          "etal" => false
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                            2 => "T&#46;D&#46; Yadav"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Gastroenterol Hepatol"
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                        "volumen" => "26"
                        "paginaInicial" => "229"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0115"
              "etiqueta" => "23"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Prospective application of the four category &#40;mild&#44; moderate&#44; severe&#44; critical&#41; classification of acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "B&#46;I&#46; Babu"
                            2 => "A&#46;K&#46; Siriwardena"
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                    ]
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                    0 => array:1 [
                      "Revista" => array:5 [
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                        "paginaInicial" => "1339"
                        "paginaFinal" => "1340"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Classification of the severity of acute pancreatitis&#58; how many categories make sense&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.597"
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                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "74"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19844203"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global survey of controversies in classifying the severity of acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;S&#46; Petrov"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "715"
                        "paginaFinal" => "721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22382706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinant-Based Classification of Acute Pancreatitis Severity an International Multidisciplinary Consultation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of the Pancreatitis Across Nations Clinical Research and Education Alliance &#40;PANCREA&#41;"
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                            2 => "P&#46; Layer"
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                    0 => array:2 [
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                        "tituloSerie" => "Ann Surg"
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                        "volumen" => "256"
                        "paginaInicial" => "875"
                        "paginaFinal" => "880"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22735715"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0135"
              "etiqueta" => "27"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute necrotizing pancreatitis&#58; treatment strategy according to the status of infection"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;W&#46; Buchler"
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                            3 => "H&#46; Friess"
                            4 => "C&#46;A&#46; Seiler"
                            5 => "W&#46; Uhl"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Ann Surg"
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                        "volumen" => "232"
                        "paginaInicial" => "619"
                        "paginaFinal" => "626"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11066131"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis"
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                          "etal" => true
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                            4 => "G&#46; Sathyanarayan"
                            5 => "N&#46;P&#46; Bohidar"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
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                        "volumen" => "3"
                        "paginaInicial" => "159"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15704050"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early antibiotic treatment for severe acute necrotizing pancreatitis&#58; a randomized&#44; double-blind&#44; placebo-controlled study"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "S&#46;W&#46; Ashley"
                            4 => "P&#46;S&#46; Barie"
                            5 => "T&#46; Dugernier"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.sla.0000250414.09255.84"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "674"
                        "paginaFinal" => "683"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17457158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presence and extent of extrapancreatic fluid collections are indicators of severe acute pancreatitis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;G&#46; Lankisch"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1385/IJGC:26:3:131"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Pancreatol"
                        "fecha" => "1999"
                        "volumen" => "26"
                        "paginaInicial" => "131"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10732289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe acute pancreatitis&#58; nonsurgical treatment of infected necroses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Runzi"
                            1 => "W&#46; Niebel"
                            2 => "H&#46; Goebell"
                            3 => "G&#46; Gerken"
                            4 => "P&#46; Layer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2005"
                        "volumen" => "30"
                        "paginaInicial" => "195"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15782093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Isenmann"
                            1 => "B&#46; Rau"
                            2 => "H&#46;G&#46; Beger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2168.1999.01176.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1999"
                        "volumen" => "86"
                        "paginaInicial" => "1020"
                        "paginaFinal" => "1024"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10460637"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing pancreatitis&#58; contemporary analysis of 99 consecutive cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;W&#46; Ashley"
                            1 => "A&#46; Perez"
                            2 => "E&#46;A&#46; Pierce"
                            3 => "D&#46;C&#46; Brooks"
                            4 => "F&#46;D&#46; Moore Jr&#46;"
                            5 => "E&#46;E&#46; Whang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2001"
                        "volumen" => "234"
                        "paginaInicial" => "572"
                        "paginaFinal" => "579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11573050"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706026453"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; aetiology and outcome of acute and chronic pancreatitis&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;W&#46; Spanier"
                            1 => "M&#46;G&#46; Dijkgraaf"
                            2 => "M&#46;J&#46; Bruno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bpg.2007.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "45"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18206812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Open pancreatic necrosectomy in the multidisciplinary management of postinflammatory necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;I&#46; Babu"
                            1 => "A&#46;J&#46; Sheen"
                            2 => "S&#46;H&#46; Lee"
                            3 => "S&#46; O&#39;Shea"
                            4 => "J&#46;M&#46; Eddleston"
                            5 => "A&#46;K&#46; Siriwardena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e3181b59303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2010"
                        "volumen" => "251"
                        "paginaInicial" => "783"
                        "paginaFinal" => "786"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20195152"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrapancreatic necrotizing pancreatitis with viable pancreas&#58; a previously under-appreciated entity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;H&#46; Sakorafas"
                            1 => "G&#46;G&#46; Tsiotos"
                            2 => "M&#46;G&#46; Sarr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Surg"
                        "fecha" => "1999"
                        "volumen" => "188"
                        "paginaInicial" => "643"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10359357"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis&#58; evaluation of a new scoring system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; de Waele"
                            1 => "L&#46; Delrue"
                            2 => "E&#46;A&#46; Hoste"
                            3 => "M&#46; de Vos"
                            4 => "P&#46; Duyck"
                             …1
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/mpa.0b013e31802d4136"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2007"
                        "volumen" => "34"
                        "paginaInicial" => "185"
                        "paginaFinal" => "190"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome in a large unselected series of patients with acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatogastroenterology"
                        "fecha" => "2009"
                        "volumen" => "56"
                        "paginaInicial" => "871"
                        "paginaFinal" => "876"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An assessment of the severity of interstitial pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cgh.2011.08.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2011"
                        "volumen" => "9"
                        "paginaInicial" => "1098"
                        "paginaFinal" => "1103"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severity prediction in acute pancreatitis&#58; the role of early CT scan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00261-007-9223-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Abdom Imaging"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "265"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice and yield of early CT scan in acute pancreatitis&#58; a Dutch Observational Multicenter Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000243731"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreatology"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "222"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute pancreatitis&#58; assessment of severity with clinical and CT evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2233010680"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2002"
                        "volumen" => "223"
                        "paginaInicial" => "603"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Computerized tomographic fine needle aspiration &#40;CT-FNA&#41; is valuable in the management of infected pancreatic necrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2005.00328_1.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2005"
                        "volumen" => "100"
                        "paginaInicial" => "2371"
                        "paginaFinal" => "2372"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute necrotizing pancreatitis&#58; management by planned&#44; staged pancreatic necrosectomy&#47;debridement and delayed primary wound closure over drains"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1991"
                        "volumen" => "78"
                        "paginaInicial" => "576"
                        "paginaFinal" => "581"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673606679336"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does an infected peripancreatic fluid collection or abscess mandate operation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2000"
                        "volumen" => "231"
                        "paginaInicial" => "361"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin &#40;PCT&#41;&#58; a prospective international multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.sla.0000252443.22360.46"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "745"
                        "paginaFinal" => "754"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis&#58; systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surg.2009.02.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgery"
                        "fecha" => "2009"
                        "volumen" => "146"
                        "paginaInicial" => "72"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does serum procalcitonin have a role in evaluating the severity of acute pancreatitis&#63; A question revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00268-006-0167-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "1713"
                        "paginaFinal" => "1721"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The SOFA &#40;Sepsis-related Organ Failure Assessment&#41; score to describe organ dysfunction&#47;failure"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine"
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "1996"
                        "volumen" => "22"
                        "paginaInicial" => "707"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early severe acute pancreatitis&#58; characteristics of a new subgroup"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2001"
                        "volumen" => "22"
                        "paginaInicial" => "274"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706001574"
                          "estado" => "S300"
                          "issn" => "07351097"
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                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and management of patients with early acute severe pancreatitis&#58; experience from a medical center in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2004"
                        "volumen" => "10"
                        "paginaInicial" => "919"
                        "paginaFinal" => "921"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early physiological response to intensive care as a clinically relevant approach to predicting the outcome in severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archsurg.139.4.438"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "2004"
                        "volumen" => "139"
                        "paginaInicial" => "438"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and reversibility of organ failure in the course of sterile or infected necrotizing pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "2001"
                        "volumen" => "136"
                        "paginaInicial" => "1386"
                        "paginaFinal" => "1390"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The study on causes of death in fulminant pancreatitis at early stage and late stage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sichuan Da Xue Xue Bao Yi Xue Ban"
                        "fecha" => "2011"
                        "volumen" => "42"
                        "paginaInicial" => "686"
                        "paginaFinal" => "690"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early management of severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11894-010-0174-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Gastroenterol Rep"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "123"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship of necrosis to organ failure in severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1997"
                        "volumen" => "113"
                        "paginaInicial" => "899"
                        "paginaFinal" => "903"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe acute pancreatitis in China&#58; etiology and mortality in 1976 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPA.0b013e3180654d20"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "232"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple organ dysfunction associated with severe acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "30"
                        "paginaInicial" => "1274"
                        "paginaFinal" => "1279"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Research Committee of Intractable Diseases of the Pancreas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPA.0b013e318214812b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2011"
                        "volumen" => "40"
                        "paginaInicial" => "503"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Scoring systems in acute pancreatitis&#58; which one to use in intensive care units&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2010"
                        "volumen" => "25"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The performance of organ dysfunction scores for the early prediction and management of severity in acute pancreatitis&#58; an exploratory phase diagnostic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPA.0b013e3181f73b19"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreas"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "1104"
                        "paginaFinal" => "1108"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of BISAP&#44; Ranson&#39;s&#44; APACHE-II&#44; and CTSI scores in predicting organ failure&#44; complications&#44; and mortality in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.622"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "435"
                        "paginaFinal" => "441"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based clinical guidelines for acute pancreatitis &#8212;diagnosis of the severity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nihon Naika Gakkai Zasshi"
                        "fecha" => "2004"
                        "volumen" => "93"
                        "paginaInicial" => "10"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of the severity of acute pancreatitis&#58; no room for complacency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000123604"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pancreatology"
                        "fecha" => "2008"
                        "volumen" => "8"
                        "paginaInicial" => "105"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The difficulty in predicting outcome in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2009.623"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "443"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181b785a2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "38"
                        "paginaInicial" => "283"
                        "paginaFinal" => "287"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of severity of acute pancreatitis according to new prognostic factors and CT grading"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00534-009-0213-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatobiliary Pancreat Sci"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "37"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting the severity of acute pancreatitis&#58; choose the right horse before hitching the cart"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-011-1924-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2011"
                        "volumen" => "56"
                        "paginaInicial" => "3402"
                        "paginaFinal" => "3404"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiopoietin-2&#44; a regulator of vascular permeability in inflammation&#44; is associated with persistent organ failure in patients with acute pancreatitis from the United States and Germany"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ajg.2010.183"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "2287"
                        "paginaFinal" => "2292"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            69 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotics and severe acute pancreatitis in Intensive Medicine&#46; Current status&#46; Recommendations of the 7<span class="elsevierStyleHsp" style=""></span>th Consensus Conference of the SEMICYUC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Medicina Intensiva"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "78"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109705025829"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New classification of acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ugeskr Laeger"
                        "fecha" => "2011"
                        "volumen" => "173"
                        "paginaInicial" => "42"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of acute pancreatitis&#58; revised Atlanta classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rcl.2012.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiol Clin N Am"
                        "fecha" => "2012"
                        "volumen" => "50"
                        "paginaInicial" => "429"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid collections in and around the pancreas in acute pancreatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCG.0b013e318213ef3e"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2011"
                        "volumen" => "45"
                        "paginaInicial" => "614"
                        "paginaFinal" => "625"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The revised Atlanta classification of acute pancreatitis&#58; its importance for the radiologist and its effect on treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.11110947"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2012"
                        "volumen" => "262"
                        "paginaInicial" => "751"
                        "paginaFinal" => "764"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            74 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The revised Atlanta classification for acute pancreatitis&#58; a CT imaging guide for radiologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10140-011-1001-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Radiol"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "237"
                        "paginaFinal" => "243"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            75 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Atlanta Classification of acute pancreatitis revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.6010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2008"
                        "volumen" => "95"
                        "paginaInicial" => "6"
                        "paginaFinal" => "21"
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                      "titulo" => "Risk and markers of severe acute pancreatitis"
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                          "autores" => array:5 [ …5]
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                        "volumen" => "36"
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                          0 => array:2 [ …2]
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                          "autores" => array:6 [ …6]
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                        "volumen" => "9"
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                        "paginaFinal" => "614"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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                          "autores" => array:5 [ …5]
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                        "link" => array:1 [
                          0 => array:2 [ …2]
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
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                        "volumen" => "17"
                        "paginaInicial" => "17"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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                  ]
                ]
              ]
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                      "titulo" => "Do guidelines influence medical practice&#63; Changes in management of acute pancreatitis 7 years after the publication of the French guidelines"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/MEG.0b013e32834d864f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "143"
                        "paginaFinal" => "148"
                        "link" => array:1 [
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        "titulo" => "Agradecimientos"
        "texto" => "<p id="par0170" class="elsevierStylePara elsevierViewall">Los siguientes pancreat&#243;logos contribuyeron al desarrollo de la clasificaci&#243;n de la pancreatitis aguda basada en factores determinantes de gravedad &#40;en orden alfab&#233;tico&#41;&#58;</p> <p id="par0175" class="elsevierStylePara elsevierViewall">Abu Hilal M &#40;United Kingdom&#41;&#44; Abu-Zidan FM &#40;United Arab Emirates&#41;&#44; Acosta JM &#40;Argentina&#41;&#44; Ainsworth AP &#40;Denmark&#41;&#44; Aizcorbe Garralda M &#40;Spain&#41;&#44; Alagozlu H &#40;Turkey&#41;&#44; Al&#8217;aref SJ &#40;Qatar&#41;&#44; Albeniz Arbizu E &#40;Spain&#41;&#44; Alhajeri A &#40;United States&#41;&#44; Almeida JL &#40;Brazil&#41;&#44; Ammori BJ &#40;United Kingdom&#41;&#44; Andersson R &#40;Sweden&#41;&#44; Ardengh JC &#40;Brazil&#41;&#44; Arroyo-Sanchez AS &#40;Peru&#41;&#44; Arvanitakis M &#40;Belgium&#41;&#44; Ashley SW &#40;United States&#41;&#44; Aygencel G &#40;Turkey&#41;&#44; Ayoub WA &#40;United States&#41;&#44; Baillie J &#40;United States&#41;&#44; Bala M &#40;Israel&#41;&#44; Ball CG &#40;Canada&#41;&#44; Banks PA &#40;United States&#41;&#44; Baron TH &#40;United States&#41;&#44; Barreto SG &#40;Australia&#41;&#44; Basaranoglu M &#40;Turkey&#41;&#44; Beger HG &#40;Germany&#41;&#44; Bernal Monterde <span class="elsevierStyleSmallCaps">V</span> &#40;Spain&#41;&#44; Besselink MG &#40;Netherlands&#41;&#44; Bharwani N &#40;United Kingdom&#41;&#44; Bhasin DK &#40;India&#41;&#44; Bong JJ &#40;Malaysia&#41;&#44; Botoi G &#40;Romania&#41;&#44; Bruennler T &#40;Germany&#41;&#44; Bruno MJ &#40;Netherlands&#41;&#44; Cairoli E &#40;Uruguay&#41;&#44; Carter CR &#40;United Kingdom&#41;&#44; Cernea D &#40;Romania&#41;&#44; Chari ST &#40;United States&#41;&#44; Chooklin S &#40;Ukraine&#41;&#44; Cochior D &#40;Romania&#41;&#44; Col C &#40;Turkey&#41;&#44; Conwell DL &#40;United States&#41;&#44; Correia MI &#40;Brazil&#41;&#44; Dambrauskas Z &#40;Lithuania&#41;&#44; Darvas K &#40;Hungary&#41;&#44; De Campos T &#40;Brazil&#41;&#44; De Casasola GG &#40;Spain&#41;&#44; De Waele JJ &#40;Belgium&#41;&#44; del Chiaro M &#40;Italy&#41;&#44; Delle Fave G &#40;Italy&#41;&#44; Dellinger EP &#40;United States&#41;&#44; de-Madaria E &#40;Spain&#41;&#44; Dervenis C &#40;Greece&#41;&#44; di Sebastiano P &#40;Italy&#41;&#44; Diuzheva TG &#40;Russia&#41;&#44; Duarte-Rojo A &#40;Mexico&#41;&#44; Fagenholz PJ &#40;United States&#41;&#44; Farkas G &#40;Hungary&#41;&#44; Farre Viladrich A &#40;Spain&#41;&#44; Fernandez-del Castillo C &#40;United States&#41;&#44; Forsmark CE &#40;United States&#41;&#44; Friess H &#40;Germany&#41;&#44; Frossard JL &#40;Switzerland&#41;&#44; Gandhi <span class="elsevierStyleSmallCaps">V</span> &#40;India&#41;&#44; Gardner TB &#40;United States&#41;&#44; Garg PK &#40;India&#41;&#44; Gloor B &#40;Switzerland&#41;&#44; Gluk M &#40;United States&#41;&#44; Goltsov VR &#40;Russia&#41;&#44; Guevara-Campos J &#40;Venezuela&#41;&#44; Gumbs AA &#40;United States&#41;&#44; Hackert T &#40;Germany&#41;&#44; Hauser G &#40;Croatia&#41;&#44; Horvath KD &#40;United States&#41;&#44; Howard TJ &#40;United States&#41;&#44; Igarashi H &#40;Japan&#41;&#44; Ioannidis O &#40;Greece&#41;&#44; Jaber S &#40;France&#41;&#44; James FE &#40;United Kingdom&#41;&#44; Jha RK &#40;China&#41;&#44; Johnson CD &#40;United Kingdom&#41;&#44; Juneja D &#40;India&#41;&#44; Kamisawa T &#40;Japan&#41;&#44; Kandasami P &#40;Malaysia&#41;&#44; Kantarcioglu M &#40;Turkey&#41;&#44; Kapoor VK &#40;India&#41;&#44; Karakan T &#40;Turkey&#41;&#44; Kaya E &#40;Turkey&#41;&#44; Khaliq A &#40;India&#41;&#44; Kiriyama S &#40;Japan&#41;&#44; Kochhar R &#40;India&#41;&#44; Konstantinou GN &#40;Greece&#41;&#44; Kylanpaa ML &#40;Finland&#41;&#44; Lankisch PG &#40;Germany&#41;&#44; Laplaza Santos C &#40;Spain&#41;&#44; Lata J &#40;Czech Republic&#41;&#44; Layer P &#40;Germany&#41;&#44; Lerch MM &#40;Germany&#41;&#44; Levy P &#40;France&#41;&#44; Lopez A &#40;Spain&#41;&#44; Lopez Camps <span class="elsevierStyleSmallCaps">V</span> &#40;Spain&#41;&#44; Lujano-Nicolas LA &#40;Mexico&#41;&#44; Lund H &#40;Denmark&#41;&#44; Lytras D &#40;Greece&#41;&#44; Macaya Redin L &#40;Spain&#41;&#44; Machado MC &#40;Brazil&#41;&#44; Macias Rodriguez MA &#40;Spain&#41;&#44; Mann O &#40;Germany&#41;&#44; Maravi-Poma E &#40;Spain&#41;&#44; Marincas M &#40;Romania&#41;&#44; Marwah S &#40;India&#41;&#44; Mas E &#40;France&#41;&#44; Matheus AS &#40;Brazil&#41;&#44; Mayerle J &#40;Germany&#41;&#44; Meier R &#40;Switzerland&#41;&#44; Mennecier D &#40;France&#41;&#44; Mifkovic A &#40;Slovakia&#41;&#44; Mofidi R &#40;United Kingdom&#41;&#44; Mole DJ &#40;United Kingdom&#41;&#44; Morris-Stiff G &#40;United Kingdom&#41;&#44; Mossner J &#40;Germany&#41;&#44; Muftuoglu MA &#40;Turkey&#41;&#44; Munsell MA &#40;United States&#41;&#44; Nathens AB &#40;Canada&#41;&#44; Neri <span class="elsevierStyleSmallCaps">V</span> &#40;Italy&#41;&#44; N¿ojgaard C &#40;Denmark&#41;&#44; Nordback <span class="elsevierStyleSmallCaps">I</span> &#40;Finland&#41;&#44; Ocampo C &#40;Argentina&#41;&#44; Olejnik J &#40;Slovakia&#41;&#44; O&#8217;Reilly DA &#40;United Kingdom&#41;&#44; Oria A &#40;Argentina&#41;&#44; Panek J &#40;Poland&#41;&#44; Papachristou GI &#40;United States&#41;&#44; Parekh D &#40;United States&#41;&#44; Parks RW &#40;United Kingdom&#41;&#44; Passaglia C &#40;Italy&#41;&#44; Pearce CB &#40;Australia&#41;&#44; Pellegrini D &#40;Argentina&#41;&#44; Perez-Mateo M &#40;Spain&#41;&#44; Petrov MS &#40;New Zealand&#41;&#44; Pettila <span class="elsevierStyleSmallCaps">V</span> &#40;Finland&#41;&#44; Pezzilli R &#40;Italy&#41;&#44; Pitchumoni CS &#40;United States&#41;&#44; Pongprasobchai S &#40;Thailand&#41;&#44; Poves Prim <span class="elsevierStyleSmallCaps">I</span> &#40;Spain&#41;&#44; Puolakkainen P &#40;Finland&#41;&#44; Pupelis G &#40;Latvia&#41;&#44; Radenkovic DV &#40;Serbia&#41;&#44; Rahman SH &#40;United Kingdom&#41;&#44; Rau B &#40;Germany&#41;&#44; Regidor Sanz E &#40;Spain&#41;&#44; Repiso A &#40;Spain&#41;&#44; Rodrigo L &#40;Spain&#41;&#44; Rydzewska G &#40;Poland&#41;&#44; S&#225;nchez-Izquierdo Riera JA &#40;Spain&#41;&#44; Savides TJ &#40;United States&#41;&#44; Scaglione M &#40;Italy&#41;&#44; Serrablo A &#40;Spain&#41;&#44; Servin-Torres E &#40;Mexico&#41;&#44; Sethu <span class="elsevierStyleSmallCaps">I</span> &#40;India&#41;&#44; Sezgin O &#40;Turkey&#41;&#44; Shankar-Hari M &#40;United Kingdom&#41;&#44; Shimosegawa T &#40;Japan&#41;&#44; Singer MV &#40;United Kingdom&#41;&#44; Sinha SK &#40;India&#41;&#44; Siriwardena AK &#40;United Kingdom&#41;&#44; Sjoberg Bexelius T &#40;Sweden&#41;&#44; Skipworth JR &#40;United Kingdom&#41;&#44; Soriano FG &#40;Brazil&#41;&#44; Sotoudehmanesh R &#40;Iran&#41;&#44; Spanier BW &#40;Netherlands&#41;&#44; Stabuc B &#40;Slovenia&#41;&#44; Stroescu C &#40;Romania&#41;&#44; Szentkereszty Z &#40;Hungary&#41;&#44; Takacs T &#40;Hungary&#41;&#44; Takada T &#40;Japan&#41;&#44; Takeda K &#40;Japan&#41;&#44; Takeyama Y &#40;Japan&#41;&#44; Talukdar R &#40;India&#41;&#44; Tang W &#40;China&#41;&#44; Tanjoh K &#40;Japan&#41;&#44; Tarnasky PR &#40;United States&#41;&#44; Teich N &#40;Germany&#41;&#44; Tellado JM &#40;Spain&#41;&#44; Tenner S &#40;United States&#41;&#44; Thomson A &#40;Australia&#41;&#44; Tireli M &#40;Turkey&#41;&#44; Tong Z &#40;China&#41;&#44; Triantopoulou C &#40;Greece&#41;&#44; Uomo G &#40;Italy&#41;&#44; Uy MC &#40;Philippines&#41;&#44; van Geenen EJ &#40;Netherlands&#41;&#44; Vege SS &#40;United States&#41;&#44; Velasco Guardado A &#40;Spain&#41;&#44; Vettoretto N &#40;Italy&#41;&#44; Wada K &#40;Japan&#41;&#44; Warshaw AL &#40;United States&#41;&#44; Whitcomb DC &#40;United States&#41;&#44; Wilson JS &#40;Australia&#41;&#44; Windsor JA &#40;New Zealand&#41;&#44; Wittau M &#40;Germany&#41;&#44; Wu BU &#40;United States&#41;&#44; Wysocki AP &#40;Australia&#41;&#44; Yan Quiros E &#40;Peru&#41;&#44; Yasuda T &#40;Japan&#41;&#44; Yu C &#40;China&#41;&#44; Zerem E &#40;Bosnia and Herzegovina&#41;&#44; Zhou <span class="elsevierStyleSmallCaps">X</span> &#40;China&#41;&#44; Zubia Olazcoaga F &#40;Spain&#41;&#44; Zyromski NJ &#40;United States&#41;&#46;</p> <p id="par0180" class="elsevierStylePara elsevierViewall">Agradecimientos al Dr&#46; Felix Zubia por su colaboraci&#243;n en la traducci&#243;n y revisi&#243;n de este documento&#46;</p>"
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ISSN: 02105691
Idioma original: Español
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