Abstract
Aims
We studied the role of obesity and the Acute Physiology and Chronic Health Evaluation (APACHE) O score in predicting the outcome in patients with acute pancreatitis (AP) using the Asia-Pacific obesity classification.
Methods
Two hundred eighty AP patients were classified into three different groups, normal weight [body mass index (BMI) = 18.5–22.9 kg/m2], overweight (BMI = 23–24.9 kg/m2) and obese (BMI > 25 kg/m2), according to the Asia-Pacific obesity classification. For all patients APACHE II scores and modified APACHE O (i.e., APACHE Oap) scores that included a factor for obesity were calculated. The patients were managed using a standard protocol, and the outcome measures were compared for different obesity groups.
Results
Of the 280 patients (mean age 40.7 years), 46.8 % were normal weight, 29.6 % overweight and 23.6 % obese. Forty-six (16.4 %) patients underwent surgery, and 61 (21.8 %) patients died. Patients with higher BMI had worse radiological indices of severity, more infected necrosis (p < 0.001), more persistent organ failure (p < 0.001) and higher requirement for percutaneous drain insertion (p = 0.04), surgery (p = 0.008) and mortality (p < 0.001). The area under the curve for predicting mortality was 0.879 for APACHE II and 0.886 for APACHE Oap; at a cutoff of 8.5, the APACHE II score had a sensitivity of 88.2 % and specificity of 68.7 %, and APACHE Oap 90.2 and 64.0 %, respectively.
Conclusions
BMI ≥ 23 kg/m2 was an important predictor of a severe disease course and fatal outcome in patients with AP. However, the predictive accuracy of APACHE Oap for mortality was similar to APACHE II.
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References
Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN. Obesity: an important prognostic factor in acute pancreatitis. Br J Surg. 1993;80:484–486.
Martínez J, Johnson CD, Sánchez-Payá J, de Madaria E, Robles-Díaz G, Pérez-Mateo M. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology. 2006;6:206–209.
Martínez J, Sánchez-Payá J, Palazón JM, Suazo-Barahona J, Robles-Díaz G, Pérez-Mateo M. Is obesity a risk factor in acute pancreatitis? A meta-analysis. Pancreatology. 2004;4:42–48.
Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diab Rep. 2005;5:70–75.
Papachristou GI, Papachristou DJ, Avula H, Slivka A, Whitcomb DC. Obesity increases the severity of acute pancreatitis: performance of APACHE-O score and correlation with the inflammatory response. Pancreatology. 2006;6:279–285.
Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology. 2004;4:1–6.
Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology. 2003;144:2195–2200.
Dandona P, Weinstock R, Thusu K, Abdel-Rahman E, Aljada A, Wadden T. Tumor necrosis factor in sera of obese patients: fall with weight loss. J Clin Endocrinol Metab. 1998;83:2907–2910.
Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;28:2131–2135.
Khaodhiar L, Ling PR, Blackburn GL, Bistrian BR. Serum levels of interleukin-6 and C-reactive protein correlate with body mass index across the broad range of obesity. J Parenter Enteral Nutr. 2004;28:410–415.
Christiansen T, Richelsen B, Bruun JM. Monocyte chemoattractant protein-1 is produced in isolated adipocytes, associated with adiposity and reduced after weight loss in morbid obese subjects. Int J Obes (Lond). 2005;29:146–150.
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.
Ranson JHC, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynaecol Obstet. 1974;139:69–81.
Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–829.
Papachristou GI, Whitcomb DC. Predictors of severity and necrosis in acute pancreatitis. Gastroenterol Clin North Am. 2004;33:871–890.
Osvaldt AB, Viero P, Costa MS, Wendt LR, Bersch VP, Rohde L. Evaluation of Ranson, Glasgow, APACHE-II, and APACHE-O criteria to predict severity in acute biliary pancreatitis. Int Surg. 2001;86:158–161.
Tan DA. Changing disease trends in the Asia-Pacific. Climacteric. 2011;14:529–534.
Pan WH, Yeh WT. How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: an extension of Asian-Pacific recommendations. Asia Pac J Clin Nutr. 2008;17:370–374.
Shin KY, Lee WS, Chung DW, et al. Influence of obesity on the severity and clinical outcome of acute pancreatitis. Gut Liver. 2011;5:335–339.
Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2006;5:294–299.
Wig JD, Gupta V, Kochhar R, Yadav TD, Poornachandra KS, Bharathy KG. The role of non-operative strategies in the management of severe acute pancreatitis. JOP. 2010;11:553–559.
Lankisch PG, Warnecke B, Bruns D, et al. The APACHE II score is unreliable to diagnose necrotizing pancreatitis on admission to hospital. Pancreas. 2002;24:217–222.
Hong S, Qiwen B, Ying J, Wei A, Chaoyang T. Body mass index and the risk and prognosis of acute pancreatitis: a meta-analysis. Eur J Gastroenterol Hepatol. 2011;23:1136–1143.
Wang SQ, Li SJ, Feng QX, Feng XY, Xu L, Zhao QC. Overweight is an additional prognostic factor in acute pancreatitis: a meta-analysis. Pancreatology. 2011;11:92–98.
Bhardwaj S, Misra A, Misra R, et al. High prevalence of abdominal, intra-abdominal and subcutaneous adiposity and clustering of risk factors among urban Asian Indians in North India. PLoS One. 2011;6:e24362.
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Thandassery, R.B., Appasani, S., Yadav, T.D. et al. Implementation of the Asia-Pacific Guidelines of Obesity Classification on the APACHE-O Scoring System and Its Role in the Prediction of Outcomes of Acute Pancreatitis: A Study from India. Dig Dis Sci 59, 1316–1321 (2014). https://doi.org/10.1007/s10620-013-3000-7
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DOI: https://doi.org/10.1007/s10620-013-3000-7