title: The Association of Computed Tomography-Assessed Body Composition with Mortality in Patients with Necrotizing Pancreatitis.
abstract: Identification of patients with necrotizing pancreatitis at high risk for a complicated course could facilitate clinical decision-making. In multiple diseases, several parameters of body composition are associated with impaired outcome, but studies in necrotizing pancreatitis are lacking.
  
  
  
  A post hoc analysis was performed in a national prospective cohort of 639 patients with necrotizing pancreatitis. Skeletal muscle mass, skeletal muscle density, and visceral adipose tissue were measured at the third lumbar vertebra level (L3) on contrast-enhanced computed tomography (CT) within 10 days after initial admission and 1 month thereafter.
  
  
  
  In total, 496 of 639 patients (78%) were included. Overall mortality rate was 14.5%. Skeletal muscle mass and density and visceral adipose tissue on first CT were not independently associated with in-hospital mortality. However, low skeletal muscle density was independently associated with increased mortality in patients ≥65 years (OR 2.54 (95%CI 1.12-5.84, P = 0.028). Skeletal muscle mass and density significantly decreased within 1 month, for both males and females, with a median relative loss of muscle mass of 12.9 and 10.2% (both P < 0.001), respectively. Skeletal muscle density decreased with 7.2 and 7.5% (both P < 0.001) for males and females, respectively. A skeletal muscle density decrease of ≥10% in 1 month was independently associated with in-hospital mortality: OR 5.87 (95%CI 2.09-16.50, P = 0.001).
  
  
  
  First CT-assessed body composition parameters do not correlate with in-hospital mortality in patients with necrotizing pancreatitis. Loss of skeletal muscle density ≥10% within the first month after initial admission, however, is significantly associated with increased mortality in these patients.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. j.vangrinsven@pancreatitis.nl.|St Antonius Hospital, Nieuwegein, The Netherlands. j.vangrinsven@pancreatitis.nl.|Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. j.vangrinsven@pancreatitis.nl.
authors.forename: Janneke
authors.initials: J
authors.lastname: van Grinsven
authors.affiliation: Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.|Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jeroen L A
authors.initials: JLA
authors.lastname: van Vugt
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Arvind
authors.initials: A
authors.lastname: Gharbharan
authors.affiliation: Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Casper H J
authors.initials: CHJ
authors.lastname: van Eijck
authors.affiliation: Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. d.boerma@antoniusziekenhuis.nl.
authors.forename: Djamila
authors.initials: D
authors.lastname: Boerma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D000066491:Clinical Decision-Making; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
keywords: Body composition; Necrotizing pancreatitis; Skeletal muscle density; Skeletal muscle mass; Visceral adipose tissue