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. 2020 Oct;20(7):1287-1295.
doi: 10.1016/j.pan.2020.08.011. Epub 2020 Aug 23.

Class III obesity rather than metabolic syndrome impacts clinical outcomes of acute pancreatitis: A propensity score weighted analysis

Alecia M Blaszczak  1 , Somashekar G Krishna  2 , Phil A Hart  2 , David Bradley  1 , Willa Hsueh  1 , Luis F Lara  2 , Hisham Hussan  2 , Alice Hinton  3 , Darwin L Conwell  2 , Zobeida Cruz-Monserrate  4
Affiliations

Class III obesity rather than metabolic syndrome impacts clinical outcomes of acute pancreatitis: A propensity score weighted analysis

Alecia M Blaszczak et al. Pancreatology. 2020 Oct.

Abstract

Objectives: The incidence rates of acute pancreatitis (AP) and the prevalence of class III obesity, and metabolic syndrome (MetS) are increasing in the US. Since class III obesity was associated with adverse clinical outcomes of AP, we sought to understand if the presence of metabolic comorbidities collectively recognized, as MetS were associated with worse clinical outcomes and increased health-care utilization.

Methods: The Nationwide Readmissions Database (NRD) (2010-2014) was reviewed to identify all adult subjects with a principal discharge diagnosis of AP. Inpatient mortality, severe AP (SAP), and 30-day readmissions were the primary outcomes analyzed. Propensity score weighted analyses were used to compare AP subjects with and without MetS and were further stratified by class III obesity status.

Results: MetS was associated with 12.91% (139,165/1,078,183) of all admissions with AP. Propensity score weighted analyses showed that MetS was associated with an increased proportion of SAP (OR 1.21, 95% CI 1.17, 1.25), but decreased mortality (OR 0.62, 95% CI 0.54, 0.70) and 30-day readmissions (OR 0.86, 95% CI 0.83, 0.89). Propensity score weighted analyses also revealed that class III obesity was independently associated with increased mortality in AP subjects with (OR 1.92, 95% CI 1.41, 2.61) and without MetS (OR 1.55, 95% CI 1.26, 1.92), and increased SAP in subjects with and without MetS.

Conclusions: Class III obesity appears to be the primary factor associated with adverse clinical outcomes in subjects with MetS admitted with AP. This has significant implications for patient management and future research targeting AP.

Keywords: Acute pancreatitis; Body mass index; Class III obesity; Metabolic syndrome; Nationwide readmissions database; Obesity.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Figure 1:
Figure 1:
Study schema to assess the impact of metabolic syndrome and class III obesity on acute pancreatitis outcomes. * The numbers for the no class III obesity and class III obesity in the no metabolic syndrome groups do not add up to exactly 939,018 because of the rounding that occurred after we applied the weights to produce national estimates. At this point the results are no longer whole numbers but have several decimal places which were then rounded by the statistical software utilized.
Figure 2.
Figure 2.
Trend Analyses using the Nationwide Readmission Database (2010 – 2014). There was a significant increase (p < 0.001) in hospitalizations with (A) acute pancreatitis (B) metabolic syndrome, (C) acute pancreatitis with metabolic syndrome, and (D) the individual components of the metabolic syndrome. Abbreviations: AP= Acute Pancreatitis, MetS = Metabolic Syndrome, BP = Blood Pressure, TG= Triglycerides, T2D= Type 2 diabetes, BMI= Body Mass Index
See this image and copyright information in PMC

References

    1. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ et al.: Burden of gastrointestinal disease in the united states: 2012 update. Gastroenterology 2012; 143: 1179–1187.e1173. - PMC - PubMed
    1. Krishna SG, Kamboj AK, Hart PA, Hinton A, Conwell DL: The changing epidemiology of acute pancreatitis hospitalizations: A decade of trends and the impact of chronic pancreatitis. Pancreas 2017; 46: 482–488. - PMC - PubMed
    1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al.: Classification of acute pancreatitis−-2012: Revision of the atlanta classification and definitions by international consensus. Gut 2013; 62: 102–111. - PubMed
    1. Buter A, Imrie CW, Carter CR, Evans S, McKay CJ: Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. The British journal of surgery 2002; 89: 298–302. - PubMed
    1. van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG: Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. The British journal of surgery 2011; 98: 18–27. - PubMed

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