Why is this important?
While it is accepted that obesity is a risk factor for severe acute pancreatitis, there are few data on the influence of sarcopenia. Hence the interest of better understanding the possible association between sarcopenia and the development of severe acute pancreatitis and of evaluating the performance of a prognostic tool for the severity of acute pancreatitis.
Methodology
This single-center retrospective study was conducted at Caen University Hospital between 2014 and 2017. It assessed the impact of sarcopenia and sarcopenic obesity on the incidence of severe pancreatitis as well as the predictive nature of severe forms of different anthropometric indices. Sarcopenia was assessed by the area of the psoas muscle by abdominal CT scan. The psoas area/body mass index (BMI) ratio reflected sarcopenic obesity. When psoas area is related to body surface area, we get the Sarcopancreatic Index. Severe acute pancreatitis is defined by the presence of infection, necrosis, or persistent organ failure.
Principle results
Overall, 467 patients (66% men, mean age 57 years) with sarcopenia during the study period were included. Among them, 23% were obese. The main causes of pancreatitis were biliary involvement (41%) and excessive alcohol consumption (32%). Of all the subjects, 14% developed a severe form of acute pancreatitis. The latter were older than the others (64 years versus 56 years, p=0.001). Whether in men or women, mean BMI and mean psoas muscle area were not significantly different between patients with severe or non-severe pancreatitis. On the other hand, there were more severe forms in obese subjects as well as in men (33% vs 21% and 31% vs 17%).
In multivariate analysis, the Sarcopancreatic index was independently associated with the occurrence of severe pancreatitis (1.455 [1,028-2,061]p=0,035).
The same was true for the Visual Analogue Scale performed during hospitalization (OR 1.236, p=0.0018), creatinine (OR 1.022, p<0.0001) and albumin (OR 0.899, p=0 .0002).
The Sarcopancreatic index could predict an episode of severe acute pancreatitis (threshold 2.1827). The rate of pancreatitis complications (rate of transfer to intensive care unit, rate of necrosis infection, mortality rate) was not different in patients who had a high or low Sarcopancreatic index.
By integrating this Sarcopancreatic score with other classic clinical-biological parameters, the researchers developed a specific index called Sarcopenia Severity Index. This made it possible to predict acute pancreatitis with an interesting performance.
