Obese patients appear to be at risk for complications of acute pancreatitis.
The Acute Physiology And Chronic Health Evaluation-II (APACHE-II) is a severity disease classification system used to predict pancreatitis outcomes.
The APACHE-O, a combination of APACHE-II and an obesity score, has been suggested to improve APACHE-II accuracy in predicting pancreatitis outcomes.
Dr Georgios Papachristoua and colleagues determined if the APACHE-O adds any predictive value to APACHE-II score.
The team also assessed whether obese patients are at increased risk of severe acute pancreatitis due to a more intense inflammatory response to pancreatic injury.
The investigative team studied 102 acute pancreatitis patients prospectively.
Using a body mass index of more than 30, the team noted that 28% of the subjects were obese.
The team found that 19 patients developed organ dysfunction, and were subsequently classified as having severe acute pancreatitis.
Receiver-operating curves for prediction of severe acute pancreatitis were calculated using admission APACHE-II and APACHE-O scores.
The team used binary logistic regression to assess if obesity is a risk for severe acute pancreatitis.
| Admission APACHE-O score was not more accurate than APACHE-II|
The investigators also used this method to determine the clinical factors associated with severe disease.
Levels of interleukin-6, monocyte chemoattractant protein-1, C-reactive protein, and Ranson's scores were compared between obese and non-obese patients.
The investigators found that admission APACHE-O and APACHE-II showed similar accuracy in predicting severe outcome.
Body mass index was identified as a significant risk for severe acute pancreatitis, and mortality.
The team noted that C-reactive protein levels, and Ranson's scores were significantly higher in obese acute pancreatitis patients.
Interleukin-6 and monocyte chemoattractant protein-1levels were higher in obese patients but did not reach statistical significance.
Dr Papachristoua's team concluded, “Obesity is an independent risk for severe acute pancreatitis.”
“Admission APACHE-O score is not more accurate than APACHE-II.”
“The study results suggest that obesity increases the severity of acute pancreatitis by amplifying the immune response to injury.”