title: Is Abdominal Fat Distribution Measured by Axial CT Imaging an Indicator of Complications and Mortality in Acute Pancreatitis?
abstract: BACKGROUND
  Obesity is an important risk-stratifying co-morbidity for many pathological conditions. Controversy exists about its influence in outcomes after acute pancreatitis (AP). This study assessed abdominal fat distribution (subcutaneous, retroperitoneal and intra-abdominal) measured using computer tomography (CT) images and related it to outcomes in patients with AP.
  
  
  METHODS
  The case notes of patients admitted with AP were identified from computerised records from 2008 to the 2013. Image analysis software was used to assess the individual abdominal fat distributions from CT images.
  
  
  RESULTS
  A total of 79 patients were included. There was no relationship between fat distribution and either severity of, or mortality from, AP. Fat distribution was not found to be an independent risk factor on multivariate analysis. There was, however, a positive correlation between retroperitoneal and intra-abdominal fat with APACHE II scores, Ranson and Glasgow score and Multiple Organ Dysfunction score (MODS) on various days following admission (r = 0.421, p = 0.0008; r = 0.469, p < 0.0001; r = 0.398, p = 0.007; r = 0.336, p = 0.011, respectively). On multiple logistical regression analysis, the only variables associated with mortality were Balthazar Severity Index, MODS and EWS with a p value of <0.0001, 0.0019 and 0.0481, respectively.
  
  
  CONCLUSIONS
  Obese patients have worse predicted outcomes as measured by the EWS, MODS and Ranson scores. Abdominal fat distribution, however, was not shown to be directly related to AP severity or mortality. The addition of fat parameters may be of use in prognostic CT severity index models, but from this data, it does not appear to be an independent risk factor of adverse outcome.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK. tch2@doctors.org.uk.
authors.forename: T C
authors.initials: TC
authors.lastname: Hall
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Stephenson
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Jones
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: W S
authors.initials: WS
authors.lastname: Ngu
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Horsfield
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rajesh
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, LE5 4PW, UK.
authors.forename: G
authors.initials: G
authors.lastname: Garcea
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging*; D000208:Acute Disease; D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D010195:Pancreatitis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Acute pancreatitis; CT; Obesity