Visceral Adipose Tissue Predicts Acute Necrosis and Multi-system Organ Failure in Acute Pancreatitis: 2016 ACG Auxiliary Award (Trainee)

Introduction: Recent evidence suggests an association between visceral adipose tissue (VAT) and severity in acute pancreatitis (AP), however its performance as a predictor of severity is lacking. The aim of this study was to determine the association of VAT with severe outcomes in AP and compare it with validated markers of severity. Methods: This was a retrospective cohort study including consecutive patients admitted to University Hospitals with AP between January 2010 and January 2015 who underwent CT scan on admission. Relevant laboratory, radiographic and other clinical data were collected. The VAT volume was estimated using the method of Linder and colleagues [Scientific Reports, 6, 2261, (2016)]. Severity was assigned based on the Revised Atlanta Classification (mild or moderate vs. severe AP). A univariable and multivariable logistic regression analysis was conducted to assess VAT as a predictor of AP severity compared to hematocrit, BUN, persistent SIRS criteria, and BISAP score. Results: 574 patients were admitted with AP from January 2010 to January 2015, of which 252 had a CT scan. A larger VAT area was found in patients with severe AP (184.9 cm2 vs 79.9cm2, p=0.006), acute necrotic collections (174.0cm2 vs 91.9cm2, p=0.003) and multi-system organ failure (150.6cm2 vs 91.0cm2, p=0.004) compared to those that did not have these outcomes. VAT improved discrimination between mild or moderate disease and severe AP compared with BMI, BUN and HCT (Table 1). A combination of VAT area and BISAP optimized prediction of severe AP compared with BISAP alone (0.83 vs 0.71 p= < 0.001).Table 1: Assessment of Predictors of Severe Pancreatitis: ROC AnalysisConclusion: Increased visceral adipose tissue is a strong predictor of severe pancreatitis, necrosis, and multi-system organ failure. Mechanistic studies are needed to explore this association.Figure 1