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Obesity Worsens Local and Systemic Complications of Necrotizing Pancreatitis and Prolongs Disease Course

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Obesity is epidemic in the USA. Limited data exist examining obesity’s influence on necrotizing pancreatitis (NP) disease course.

Methods

Retrospective review of prospectively maintained database of 571 adult necrotizing pancreatitis patients treated between 2007 and 2018. Patients were grouped according to body mass index (BMI) at disease onset. Patient characteristics, necrotizing pancreatitis course, and outcomes were compared between non-obese (BMI < 30) and obese (BMI > 30) patients.

Results

Among 536 patients with BMI data available, 304 (57%) were obese (BMI > 30), and 232 (43%) were non-obese (BMI < 30). NP etiology in the obese group was more commonly biliary (55% versus 46%, p = 0.04) or secondary to hypertriglyceridemia (10% versus 2%, p < 0.001) and less commonly alcohol (17% versus 26%, p = 0.01). Obese patients had a higher incidence of baseline comorbid disease. The CT severity index was similar between groups though obese patients had a higher rate of > 50% pancreatic gland necrosis (27% versus 19%, p = 0.02). The rates of infected necrosis and organ failure were higher among obese patients. Percutaneous drainage was more common in obese patients. Time to first necrosis intervention was earlier with increasing BMI. NP disease duration was longer in obese patients. The overall mortality rate of non-obese and obese patients did not differ. However, mortality rate increased with increasing BMI.

Conclusion

Necrotizing pancreatitis in obese patients is characterized by a prolonged disease course, a higher risk of organ failure, infected necrosis, and the need for early necrosis-related intervention. Mortality increases with increasing BMI.

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References

  1. Ogden CL, C.M., Fryar CD, Flegal KM, Prevalence of Obesity Among Adults and Youth: United States, 2011-2014. NCHS Data Brief 2015. 219: p. 1-8.

    Google Scholar 

  2. Khatua, B., B. El-Kurdi, and V.P. Singh, Obesity and pancreatitis. Curr Opin Gastroenterol, 2017. 33(5): p. 374-382.

    Article  CAS  Google Scholar 

  3. Maatman TK, R.A., Ceppa EP, Easler JJ, Gromski MA, House MG, Nakeeb A, Schmidt CM, Sherman S, Zyromski NJ. , The continuum of complications in survivors of necrotizing pancreatitis. Surgery, 2020. 168(6): p. 1032-1040.

    Article  Google Scholar 

  4. Roch, A.M., et al., Percutaneous Gastrostomy in Necrotizing Pancreatitis: Friend or Foe? J Gastrointest Surg 24(12) 2800-2806.

    Article  Google Scholar 

  5. Roch, A.M., et al., Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk. J Gastrointest Surg, 2019. 23(12): p. 2430-2438.

    Article  Google Scholar 

  6. Maatman, T.K., et al., Prospective Analysis of the Mechanisms Underlying Ineffective Deep Vein Thrombosis Prophylaxis in Necrotizing Pancreatitis. J Am Coll Surg., 2021. 232(1): p. 91-100.

    Article  Google Scholar 

  7. Balthazar, E., et al., Acute Pancreatitis: Value of CT in Establishing Prognosis. Radiology, 1990. 174(2): p. 331-6.

    Article  CAS  Google Scholar 

  8. Gürleyik, G., et al., Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis. Jop, 2005. 6(6): p. 562-7.

    PubMed  Google Scholar 

  9. Banks, P.A., et al., Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013. 62(1): p. 102-11.

    Article  Google Scholar 

  10. Working Group IAP/APA Acute Pancreatitis Guidelines, IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013. 13(4 Suppl 2): p. e1-15.

    Google Scholar 

  11. Mortele, K.J., et al., A Modified CT Severity Index for Evaluating Acute Pancreatitis: Improved Correlation with Patient Outcome. AJR Am J Roentgenol, 2004. 183(5): p. 1261-5.

    Article  Google Scholar 

  12. Marshall, J., et al., Multiple Organ Dysfunction Score: A Reliable Descriptor of a Complex Clinical Outcome. Critical Care Medicine, 1995. 23(10): p. 1638-52.

    Article  CAS  Google Scholar 

  13. Kozarek, R. and L. Traverso, Pancreatic fistulas: etiology, consequences, and treatment. Gastroenterologist, 1996. 4(4): p. 239-44.

    Google Scholar 

  14. Sandrasegaran, K., et al., Disconnection of the Pancreatic Duct: An Important But Overlooked Complication of Severe Acute Pancreatitis. Radiographics, 2007. 27(5): p. 1389-400.

    Article  Google Scholar 

  15. Prevention, C.f.D.C.a. Overweight and Obesity 2019 [cited 2021 May 3 ]; Available from: https://www.cdc.gov/obesity/index.html.

  16. Papachristou, G.I., et al., Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology, 2006. 6(4): p. 279-85.

    Article  Google Scholar 

  17. Johnson, C.D., S.K. Toh, and M.J. Campbell, Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology, 2004. 4(1): p. 1-6.

    Article  CAS  Google Scholar 

  18. Chen, S.M., G.S. Xiong, and S.M. Wu, Is obesity an indicator of complications and mortality in acute pancreatitis? An updated meta-analysis. J Dig Dis, 2012. 13(5): p. 244-51.

    PubMed  Google Scholar 

  19. Premkumar, R., et al., The clinical relevance of obesity in acute pancreatitis: targeted systematic reviews. Pancreatology, 2015. 15(1): p. 25-33.

    Article  Google Scholar 

  20. Choi, J., L. Joseph, and L. Pilote, Obesity and C-reactive protein in various populations: a systematic review and meta-analysis. Obes Rev, 2013. 14(3): p. 232-44.

    Article  CAS  Google Scholar 

  21. Marques-Vidal, P., et al., Association between inflammatory and obesity markers in a Swiss population-based sample (CoLaus Study). Obes Facts, 2012. 5(5): p. 734-44.

    Article  CAS  Google Scholar 

  22. Zyromski, N.J., et al., A murine model of obesity implicates the adipokine milieu in the pathogenesis of severe acute pancreatitis. Am J Physiol Gastrointest Liver Physiol, 2008. 295(3): p. G552-8.

    Article  CAS  Google Scholar 

  23. Navina, S., et al., Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med, 2011. 3(107): p. 107ra110.

    Article  Google Scholar 

  24. Yashima, Y., et al., A large volume of visceral adipose tissue leads to severe acute pancreatitis. J Gastroenterol, 2011. 46(10): p. 1213-8.

    Article  Google Scholar 

  25. Mullen, J.T., D.W. Moorman, and D.L. Davenport, The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg, 2009. 250(1): p. 166-72.

    Article  Google Scholar 

  26. Patel, J.J., et al., The Critical Care Obesity Paradox and Implications for Nutrition Support. Curr Gastroenterol Rep, 2016. 18(9): p. 45.

    Article  Google Scholar 

  27. Rossi, A.P., et al., Predictors of ectopic fat accumulation in liver and pancreas in obese men and women. Obesity (Silver Spring), 2011. 19(9): p. 1747-54.

    Article  CAS  Google Scholar 

  28. Nguyen, N.H., et al., Annual Burden and Costs of Hospitalization for High-Need, High-Cost Patients With Chronic Gastrointestinal and Liver Diseases. Clin Gastroenterol Hepatol, 2018. 16(8): p. 1284-1292.e30.

    Article  Google Scholar 

  29. Meng, L., et al., Comprehensive Guidance for Antibiotic Dosing in Obese Adults. Pharmacotherapy, 2017. 37(11): p. 1415-1431.

    Article  Google Scholar 

  30. Zhang, T., et al., Gut Dysbiosis in Pancreatic Diseases: A Causative Factor and a Novel Therapeutic Target. Front Nutr, 2022. 9: p. 814269.

    Article  Google Scholar 

  31. Wu, L.M., et al., Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Br J Surg, 2014. 101(13): p. 1644-56.

    Article  CAS  Google Scholar 

  32. Thomas, R.M. and C. Jobin, Microbiota in pancreatic health and disease: the next frontier in microbiome research. Nat Rev Gastroenterol Hepatol, 2020. 17(1): p. 53-64.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine and Indiana University Health, 545 Barnhill Dr., Emerson Hall 519, Indianapolis, IN, 46202, USA

    Sean P. McGuire, Sydney L. Keller, Thomas K. Maatman, Kyle A. Lewellen, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, Trang K. Nguyen, C. Max Schmidt & Nicholas J. Zyromski

  2. Department of Surgery, Eastern Health, St. Johns, NL, Canada

    Stephen N. Quigley

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  1. Sean P. McGuire
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  2. Sydney L. Keller
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  4. Kyle A. Lewellen
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  5. Eugene P. Ceppa
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Contributions

SP McGuire, SL Keller, TK Maatman, and KA Lewellen were involved in acquisition, analysis, and interpretation of data. SP McGuire and NJ Zyromski drafted and revised the manuscript. SP McGuire, TK Maatman, EP Ceppa, MG House, A Nakeeb, TK Nguyen, SN Quigley, CM Schmidt, and NJ Zyromski were involved in the conception of the project, interpretation of the data, and revision of work. All authors were involved in the final approval. NJ Zyromski serves as the mentor and corresponding author and agrees to be accountable for the work.

Corresponding author

Correspondence to Nicholas J. Zyromski.

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This work was presented at the Digestive Disease Week in May 2021.

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McGuire, S.P., Keller, S.L., Maatman, T.K. et al. Obesity Worsens Local and Systemic Complications of Necrotizing Pancreatitis and Prolongs Disease Course. J Gastrointest Surg 26, 2128–2135 (2022). https://doi.org/10.1007/s11605-022-05383-0

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