Abstract
It is important to clarify the severity of acute pancreatitis (AP) in the early stages of the disease. The visceral adiposity index (VAI), calculated using the waist circumference (WC), body mass index (BMI), triglyceride (TG) levels, and high-density lipoprotein cholesterol (HDL-c), indirectly reflects visceral adiposity function and can be used to explore its value in evaluating and predicting the severity of hyperlipidaemic acute pancreatitis (HLAP). The VAIs of 227 patients with HLAP were calculated by retrospective analysis of body parameters and laboratory indicators. The correlation between the VAI and HLAP severity, local complications, and systemic inflammatory response syndrome (SIRS) response was analysed. The VAI was significantly higher in patients with severe and moderately severe AP than in patients with mild AP (both p < 0.05). Length of hospital stay (LOS), AP severity, systemic complications, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and SIRS score were significantly correlated with the VAI in HLAP patients. The VAI had the highest area under the curve of receiver operating characteristics (ROC) (0.755, 95% confidence interval [CI], 0.691–0.819) for predicting AP severity. The multivariate-adjusted odds ratio (HR) for the VAI in the relationship of body parameters and the severity of HLAP was 3.818 (95% CI, 1.395–10.452). Our study shows that the VAI is a valuable indicator for predicting and assessing the severity of hyperlipidaemic acute pancreatitis. Its increase is closely related to poor prognosis in patients with HLAP.
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References
Premkumar R, Phillips AR, Petrov MS, Windsor JA (2015) The clinical relevance of obesity in acute pancreatitis: targeted systematic reviews. Pancreatology 15(1):25–33. https://doi.org/10.1016/j.pan.2014.10.007
Yang L, Liu J, Xing Y, Du L, Chen J, Liu X et al (2017) Correlation of body mass index and waist-hip ratio with severity and complications of hyperlipidemic acute pancreatitis in Chinese patients. Gastroenterol Res Pract 2017:6757805. https://doi.org/10.1155/2017/6757805
Kuan LL, Dennison AR, Garcea G (2020) Association of visceral adipose tissue on the incidence and severity of acute pancreatitis: a systematic review. Pancreatology 20(6):1056–1061. https://doi.org/10.1016/j.pan.2020.05.027
Yashima Y, Isayama H, Tsujino T, Nagano R, Yamamoto K, Mizuno S et al (2011) A large volume of visceral adipose tissue leads to severe acute pancreatitis. J Gastroenterol 46(10):1213–1218. https://doi.org/10.1007/s00535-011-0430-x
Pascot A, Lemieux S, Lemieux I, Prud’homme D, Tremblay A, Bouchard C et al (1999) Age-related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women. Diabetes Care 22(9):1471–1478. https://doi.org/10.2337/diacare.22.9.1471
Bruunsgaard H, Pedersen BK (2003) Age-related inflammatory cytokines and disease. Immunol Allergy Clin North Am 23(1):15–39. https://doi.org/10.1016/s0889-8561(02)00056-5
DeNino WF, Tchernof A, Dionne IJ, Toth MJ, Ades PA, Sites CK et al (2001) Contribution of abdominal adiposity to age-related differences in insulin sensitivity and plasma lipids in healthy nonobese women. Diabetes Care 24(5):925–932. https://doi.org/10.2337/diacare.24.5.925
Rader DJ (2007) Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus. Am J Med 120(3 Suppl 1):S12–S18. https://doi.org/10.1016/j.amjmed.2007.01.003
Despres JP (2006) Intra-abdominal obesity: an untreated risk factor for type 2 diabetes and cardiovascular disease. J Endocrinol Invest 29(3 Suppl):77–82
Sironi AM, Gastaldelli A, Mari A, Ciociaro D, Positano V, Buzzigoli E et al (2004) Visceral fat in hypertension: influence on insulin resistance and beta-cell function. Hypertension 44(2):127–133. https://doi.org/10.1161/01.HYP.0000137982.10191.0a
Shapiro AM, Pokrywczynska M, Ricordi C (2017) Clinical pancreatic islet transplantation. Nat Rev Endocrinol 13(5):268–277. https://doi.org/10.1038/nrendo.2016.178
Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M et al (2010) Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 33(4):920–922. https://doi.org/10.2337/dc09-1825
Li J, Chen J, Tang W (2019) The consensus of integrative diagnosis and treatment of acute pancreatitis-2017. J Evid Based Med 12(1):76–88. https://doi.org/10.1111/jebm.12342
Zhu Y, Pan X, Zeng H, He W, Xia L, Liu P et al (2017) A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised Atlanta classification in Jiangxi, China over an 8-year period. Pancreas 46(4):504–509. https://doi.org/10.1097/mpa.0000000000000776
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al (2013) Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111. https://doi.org/10.1136/gutjnl-2012-302779
Mounzer R, Langmead CJ, Wu BU, Evans AC, Bishehsari F, Muddana V et al (2012) Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 142(7):1476–1482. https://doi.org/10.1053/j.gastro.2012.03.005 (quiz e15–6)
Staubli SM, Oertli D, Nebiker CA (2015) Laboratory markers predicting severity of acute pancreatitis. Crit Rev Clin Lab Sci 52(6):273–283. https://doi.org/10.3109/10408363.2015.1051659
Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN (2018) Initial medical treatment of acute pancreatitis: American gastroenterological association institute technical review. Gastroenterology 154(4):1103–1139. https://doi.org/10.1053/j.gastro.2018.01.031
Martinez J, Johnson CD, Sanchez-Paya J, de Madaria E, Robles-Diaz G, Perez-Mateo M (2006) Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology 6(3):206–209. https://doi.org/10.1159/000092104
Ogden CL, Carroll MD, Kit BK, Flegal KM (2014) Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311(8):806–814. https://doi.org/10.1001/jama.2014.732
Yoon SB, Choi MH, Lee IS, Lim C-H, Kim JS, Cho YK et al (2017) Impact of body fat and muscle distribution on severity of acute pancreatitis. Pancreatology 17(2):188–193. https://doi.org/10.1016/j.pan.2017.02.002
Natu A, Stevens T, Kang L, Yasinow S, Mansoor E, Lopez R et al (2017) Visceral adiposity predicts severity of acute pancreatitis. Pancreas 46(6):776–781. https://doi.org/10.1097/MPA.0000000000000845
O’Leary DP, O’Neill D, McLaughlin P, O’Neill S, Myers E, Maher MM et al (2012) Effects of abdominal fat distribution parameters on severity of acute pancreatitis. World J Surg 36(7):1679–1685. https://doi.org/10.1007/s00268-011-1414-y
Xie J, Xu L, Pan Y, Li P, Liu Y, Pan Y et al (2019) Impact of visceral adiposity on severity of acute pancreatitis: a propensity score-matched analysis. BMC Gastroenterol 19(1):87. https://doi.org/10.1186/s12876-019-1015-z
Acknowledgements
We thank all the individuals that contributed to this study. We thank all the doctors and nurses in the Department of Pancreatitis Center of the First Affiliated Hospital of Wenzhou Medical University for their hard work.
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Dr. Yu is supported by a grant from The Scientific Research Foundation of Wenzhou, Zhejiang Province, China (project No. Y2020041).
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LS and HY conceived, designed, and directed the study. HY and YH performed the data analysis. WX performed the statistical analysis. All other co-authors recruited study subjects and collected clinical data. WX drafted the manuscript with substantial help from LS. All authors contributed to the intellectual content with critical revisions and approved the final version of the manuscript.
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Ethical approval was obtained at in the First Affiliated Hospital of Wenzhou Medical University (date 14.02.2019, Ethics number KY2019-011, Ethics Committee, the First Affiliated Hospital of Wenzhou Medical University).
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Xia, W., Yu, H., Huang, Y. et al. The visceral adiposity index predicts the severity of hyperlipidaemic acute pancreatitis. Intern Emerg Med 17, 417–422 (2022). https://doi.org/10.1007/s11739-021-02819-4
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DOI: https://doi.org/10.1007/s11739-021-02819-4