Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition

Ying Zhou; Ningbo Hao; Zhongping Duan; Ming Kong; Manman Xu; Dan Zhang; Xiangxiang Xu; Qingwen Yuan; Changzheng Li

doi:10.2147/IJGM.S322589

Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition

Int J Gen Med. 2021 Jul 27:14:3971-3980. doi: 10.2147/IJGM.S322589. eCollection 2021.

Authors

Ying Zhou^#^{1

2}, Ningbo Hao^#², Zhongping Duan³, Ming Kong³, Manman Xu³, Dan Zhang², Xiangxiang Xu², Qingwen Yuan^{1

2}, Changzheng Li²

Affiliations

¹ Postgraduate Training Base of Jinzhou Medical University, Jinzhou, People's Republic of China.
² Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China.
³ Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, You'an Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Objective: The aim of this study was to investigate the possible association of muscle and adipose parameters with the severity and prognosis of patients hospitalized with acute pancreatitis (AP).

Methods: A total of 392 hospitalized patients and 309 controls were enrolled in the study analysis from April 1, 2016, to February 1, 2021. The computed tomography scans of each population were evaluated for muscle and adipose parameters. The effects of parameters on developing moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) were evaluated using univariate and multivariate logistic regression analyses. Associations with disease recurrence and death were analyzed through Cox regression analysis.

Results: The AP patients had higher levels of visceral adipose tissue (144.25 vs 97.81 cm², p < 0.001) and subcutaneous adipose tissue (135 vs 120 cm², p < 0.001) but lower levels of adipose tissue attenuation (visceral and subcutaneous) and skeletal muscle attenuation (SMA) than the controls (p < 0.05, respectively). Visceral adipose tissue (VAT) and SMA differed significantly with p-values of 0.014 and 0.003 in the different severity groups of AP. In multivariate analysis, VAT and SMA were associated with MSAP or SAP, with odds ratios of 1.003 and 0.973, respectively (95% CI 1.000-1.006, p = 0.041; 95% CI 0.953-0.993, p = 0.010). Cox regression analysis showed that low SMA was strongly associated with an increased mortality in MSAP and SAP patients (HR 10.500, 95% CI 1.344-82.025, p = 0.025). Regression analysis also showed an association of VAT loss of more than 17% with reduced 1-year recurrence of acute pancreatitis (HR 0.427, 95% CI 0.189-0.967, p = 0.041).

Conclusion: VAT and SMA were influential factors for the severity and prognosis of patients with AP. Patients should proper diet and exercise after discharge to reduce VAT and strengthen muscle function to improve prognosis.

Keywords: recurrent acute pancreatitis; skeletal muscle attenuation; subcutaneous adipose tissue; visceral adipose tissue.