November 12, 2014
Notes: Thai, Theresa C
Riherd, Daniel M
Rust, Kermit R
AJR Am J Roentgenol. 2013 Dec;201(6):W877-92. doi: 10.2214/AJR.13.10834.
Author Address: 1 Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Reference Type: Journal Article
Record Number: 4796Author: Thandassery, R. B., Appasani, S., Yadav, T. D., Dutta, U., Indrajit, A., Singh, K. and Kochhar, R.
Title: Implementation of the Asia-Pacific guidelines of obesity classification on the APACHE-O scoring system and its role in the prediction of outcomes of acute pancreatitis: a study from India
Journal: Dig Dis Sci
Short Title: Implementation of the Asia-Pacific guidelines of obesity classification on the APACHE-O scoring system and its role in the prediction of outcomes of acute pancreatitis: a study from India
Alternate Journal: Digestive diseases and sciences
ISSN: 1573-2568 (Electronic)
Accession Number: 24374646
Body Mass Index
Abstract: AIMS: We studied the role of obesity and the Acute Physiology and Chronic Health Evaluation (APACHE) O score in predicting the outcome in patients with acute pancreatitis (AP) using the Asia-Pacific obesity classification. METHODS: Two hundred eighty AP patients were classified into three different groups, normal weight [body mass index (BMI) = 18.5-22.9 kg/m(2)], overweight (BMI = 23-24.9 kg/m(2)) and obese (BMI > 25 kg/m(2)), according to the Asia-Pacific obesity classification. For all patients APACHE II scores and modified APACHE O (i.e., APACHE Oap) scores that included a factor for obesity were calculated. The patients were managed using a standard protocol, and the outcome measures were compared for different obesity groups. RESULTS: Of the 280 patients (mean age 40.7 years), 46.8% were normal weight, 29.6% overweight and 23.6% obese. Forty-six (16.4%) patients underwent surgery, and 61 (21.8%) patients died. Patients with higher BMI had worse radiological indices of severity, more infected necrosis (p < 0.001), more persistent organ failure (p < 0.001) and higher requirement for percutaneous drain insertion (p = 0.04), surgery (p = 0.008) and mortality (p < 0.001). The area under the curve for predicting mortality was 0.879 for APACHE II and 0.886 for APACHE Oap; at a cutoff of 8.5, the APACHE II score had a sensitivity of 88.2% and specificity of 68.7%, and APACHE Oap 90.2 and 64.0%, respectively. CONCLUSIONS: BMI >/= 23 kg/m(2) was an important predictor of a severe disease course and fatal outcome in patients with AP. However, the predictive accuracy of APACHE Oap for mortality was similar to APACHE II.