Study on the Predictive Value of Abdominal Fat Content and Distribution in the Acute Pancreatitis and Its Severity

Abstract

Background Acute pancreatitis (AP) is a common acute abdominal abdomen, and severe AP has considerable mortality. Early and accurate identification of AP is critical for the prevention, treatment and prognosis evaluation of AP. Studies have shown that obesity is associated with the incidence and clinical outcome of AP. However, there is a lack of obesity-related quantitative indices for the diagnosis and evaluation of AP. Objective To investigate the relationship of abdominal fat content and distribution with AP and its severity, providing a scientific basis for the prevention, diagnosis and treatment of AP. Methods One hundred AP patients (including 75 with non-severe AP and 25 with severe AP) and 100 non-AP patients〔AP was diagnosed by Chinese Guidelines for the Management of Acute Pancreatitis (Shenyang, 2019) 〕were selected from Department of General Surgery, the Southwest Hospital of AMU from January 2019 to June 2021. Clinical data were collected, including sex, age, underlying disease (hypertension, diabetes or hyperlipidemia) , history of biliary tract disease, BMI, areas of CT-assessed abdominal subcutaneous adipose tissue (SAT) , visceral adipose tissue (VAT) and total abdominal adipose tissue (TAT) , and calculated VAT/SAT ratio and VAT/TAT ratio. Multivariate Logistic regression analysis was conducted to identify factors associated with AP and its severity. ROC analysis was conducted to estimate the diagnostic value and efficiency of BMI, and indices related to abdominal fat content and distribution for the prevalence and severity of AP. Results The proportion of BMI and hyperlipidemia in AP group was higher than that in non-AP group (P<0.05) . VAT, TAT, VAT/SAT and VAT/TAT in AP group were higher than those in non-AP group (P<0.05) . VAT, TAT, VAT/SAT and VAT/TAT in severe AP subgroup were higher than those in non-severe AP subgroup (P<0.05) . Multivariate Logistic analysis showed that BMI〔OR=1.985, 95%CI (1.616, 2.438) 〕, VAT〔OR=1.126, 95%CI (1.088, 1.165) 〕, TAT〔OR=1.028, 95%CI (1.019, 1.038) 〕 were associated with AP (P<0.05) . BMI〔OR=7.543, 95%CI (2.576, 22.088) 〕and TAT〔OR=1.074, 95%CI (1.038, 1.111) 〕were associated with the severity of AP (P<0.05) . For predicting AP, the AUC of BMI was 0.833〔95%CI (0.777, 0.888) , P<0.001〕, with 90.0% sensitivity and 62.0% specificity when the optimal cut-off value was chosen as 17.610 kg/m2; the AUC of VAT was 0.939〔95%CI (0.909, 0.969) , P<0.001〕, with 84.0% sensitivity and 89.0% specificity when the optimal cut-off value was chosen as 104.250 cm2; the AUC of TAT was 0.800〔95%CI (0.739, 0.860) , P<0.001〕, with 83.0% sensitivity and 66.0% specificity when the optimal cut-off value was chosen as 184.995 cm2. When it comes to predicting the severity of AP, the AUC of TAT was 0.910〔95%CI (0.844, 0.976) , P<0.001〕, with 84.0% sensitivity and 84.0% specificity when the optimal cut-off value was chosen as 201.357 cm2, and the AUC of BMI was 0.928〔95%CI (0.856, 1.000) , P<0.001〕, with 88.0% sensitivity and 89.3% specificity when the optimal cut-off value was chosen as 21.180 kg/m2. Conclusion CT-assessed abdominal fat content and distribution may be closely associated with AP and its severity. It is suggested to include CT quantitative measurement of abdominal fat content and distribution in the AP diagnosis, severity assessment and treatment system since the two indicators reflect relevant information that could be used as scientific evidence.

Keywords

• pancreatitis|acute pancreatitis|computed tomography|subcutaneous adipose tissue|viscera adipose tissue|diagnosis|prediction