Prediction of severity and prognosis for visceral adipose tissue in obese patients with acute pancreatitis
10.3760/cma.j.cn115667-20240807-00131
- VernacularTitle:内脏脂肪组织预测肥胖型急性胰腺炎患者严重程度和预后的意义
- Author:
Dalin LUO
1
;
Jinling HANG
;
Dan LI
;
Chuanchun LIU
Author Information
1. 重庆市东南医院重症医学科，重庆 400015
- Publication Type:Journal Article
- Keywords:
Acute pancreatitis;
Visceral fat;
Obesity;
Disease severity;
Prognosis
- From:
Chinese Journal of Pancreatology
2025;25(3):190-197
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the relationship between visceral adipose tissue (VAT) and the severity and prognosis of obese patients with acute pancreatitis (AP).Methods:The clinical data of 224 obese patients with AP admitted to The Third Affiliated Hospital of Chongqing Medical University and Chongqing Dongnan Hospital from January 2020 to December 2023 were collected, retrospectively. According to the severity of AP, they were divided into mild AP group (MAP group), moderately severe AP group (MSAP group), and severe AP group (SAP group). According to the in-hospital treatment outcomes of the patients, they were divided into the survival group and death group (death within 7-30 days after admission). The basic information of AP patients, the severity score of AP and laboratory indicators were collected. The visceral adiposity index (VAI) was calculated through the values of waist circumference, body mass index, triglycerides and high-density lipoprotein cholesterol; and the VAT area was measured by CT scan. The Spearman rank correlation analysis method was used to evaluate the correlation between the VAT area and the AP severity index as well as other indicators. Multivariate logistic regression analysis was used to analyze the influencing factors of in-hospital mortality in obese patients with AP. The receiver operating characteristic curve (ROC) was drawn, and the area under curve (AUC), cut-off value, sensitivity and specificity were calculated to evaluate the predictive value of VAT area for SAP, as well as the predictive value of VAT area for in-hospital mortality in obese AP patients.Results:The VAI of MAP group, MSAP group and SAP group were 1.63(1.21, 2.74), 2.30(1.28, 3.36) and 3.01(2.17, 3.86), respectively, and the VAT area were 138.90(121.30, 155.10)cm 2, 149.90(135.10, 166.70)cm 2 and 192.30(168.80, 223.80)cm 2, respectively. There were significant differences in VAI and VAT area among the three groups (all P values <0.05). Compared with MAP group, the area of VAI and VAT area in MSAP group and SAP group were significantly increased ( P<0.05), and the area of VAT in SAP group was further increased than that in MSAP group, the differences were statistically significant (all P values <0.05). Spearman analysis showed that the VAT area was significantly positively correlated with acute physiology and chronic health evaluationⅡ scoring system (APACHEⅡ) score, modified CT severity index (MCTSI), and Balthazar CT grading score (all P values <0.05). It was also significantly positively correlated with body mass index, serum glycated hemoglobin, triglycerides, low-density lipoprotein cholesterol and VAI (all P values <0.05). ROC analysis showed that the AUC value of VAI in identifying SAP was 0.641 (95% CI 0.562-0.720), the corresponding cut-off value was 2.75, the sensitivity was 57.6%, and the specificity was 69.0%; The AUC value of VAT area in identifying SAP was 0.869 (95% CI 0.813-0.924), the corresponding cut-off value was 165.85 cm 2, the sensitivity was 78.8%, and the specificity was 84.8%, and the predictive value of VAT area was significantly better than that of VAI ( P<0.001). The APACHEⅡ, MCTSI, Balthazar CT grading score, VAI and VAT area in the death group were significantly higher than those in the survival group, and the differences were statistically significant (all P values <0.05). Multivariate logistic regression analysis showed that VAT area was an independent predictor of in-hospital mortality in obese AP patients ( P<0.05), with an AUC value of 0.831 (95% CI 0.756-0.907), a cutoff value of 173.70 cm 2, a sensitivity of 77.8%, and a specificity of 85.5%. Conclusions:The VAT area is significantly associated with the aggravation of AP and the increased risk of in-hospital mortality in obese patients, and is expected to serve as a reliable indicator for predicting the severity and prognosis of obese patients with AP.
