Severe Obesity Predicts Adverse Outcomes in Acute Pancreatitis

Abstract

Introduction: Obesity has been associated with an increased risk of pancreatitis and likelihood of systemic inflammatory response syndrome (SIRS) in those who develop pancreatic inflammation. Its impact on the severity of acute pancreatitis based on the revised Atlanta classification (2012) is unknown. This study aims to determine whether a Body Mass Index (BMI) greater than or equal to 35 (severe obesity) is correlated with pancreatitis severity. Methods: Patients presenting with acute pancreatitis were identified as part of an ongoing randomized controlled trial of goal directed fluid therapy for acute pancreatitis (NCT 01761539). Detailed data regarding their clinical course was prospectively collected. Body mass index > 35 was the primary predictor. The primary outcome, severe pancreatitis, was defined as persistent organ failure or systemic complications lasting >48 hours in accordance with the revised Atlanta Classification. Secondary outcomes included SIRS on admission and at 24 hours, length of hospitalization, time to tolerance of enteral diet, ICU admission, intubation/pressor requirements, and mortality. Results: Among 175 patients who presented with acute pancreatitis, 26 patients had a BMI ≥ 35. Patients with a BMI ≥ 35 were more likely to be female and have gallstones as the etiology of their pancreatitis (57.7%). Compared to patients with a BMI ≤ 35, patients with a BMI ≥ 35 were more likely to develop severe (OR 3.73; 95% CI (0.83-16.68)) and fatal (OR 6.34; 95% CI (1.21-33.4)) pancreatitis (Table 1). Though there was no difference in ICU admission or SIRS, patients with BMI ≥ 35 were more likely to require endotracheal intubation and/or pressor support for hypotension than those with a BMI ≤ 35. Additionally, compared to patients with a BMI ≤ 35, patients with a BMI ≥ 35 had a longer hospitalization (8.3 ± 1.1 vs 5.4 ± 0.44, p=0.01) and days to enteral diet tolerance (5.7 ± 0.8 vs 3.2 ± 0.33, p < 0.01).Table 1: Acute Pancreatis Outcomes in those with Severe ObesityConclusion: Severe obesity is associated with severe and fatal pancreatitis. These patients should be vigilantly monitored for systemic complications. Basic and translational research studying the interplay between pancreatitis, visceral adiposity, and systemic inflammation are needed.