Division of Pediatric Gastroenterology, Hepatology, and Nutrition, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
Rush University Medical Center, Chicago, Illinois, USA.
Pediatr Obes. 2020 Aug;15(8):e12643. doi: 10.1111/ijpo.12643. Epub 2020 May 14.
Morbid obesity is proinflammatory has been associated with adverse clinical outcomes in acute pancreatitis (AP) among adults. Obesity is increasingly prevalent in children and hence, we sought to evaluate the impact of morbid obesity on the clinical outcomes of AP using a large paediatric population-based cohort.
We analysed the US Kids' Inpatient Database between years 2003 and 2016 to include all patients (age ≤ 21 years) with a primary diagnosis of AP using specific ICD-9-CM and ICD-10-CM codes. We compared clinical outcomes between children without obesity (controls) and those with morbid obesity (cases). The primary outcome was severe AP (2012 revised Atlanta classification) and secondary outcomes included healthcare resource utilization (length of stay and hospital costs).
Among 36 698 paediatric AP hospitalizations, 1275 (3.5%) were found to have morbid obesity. From 2003 to 2016, the proportion of children with morbid obesity among AP patients increased from 1.3% to 5.5% (P < .001). More than half (54%) of the children with morbid obesity were presented with cholelithiasis as contributive aetiology. The prevalence of severe AP was significantly higher in morbid obesity (7.3% vs 3.8%, P < .001). Multivariate analysis revealed that morbid obesity was increasingly associated with severe AP (OR 1.79, 95% CI 1.4, 2.26), prolonged hospitalization (by 0.41 days, P = .03), and higher hospital costs (by $1596, P < .001).
Unlike adult population, there is a lack of other confounding comorbidities in children and this national-level analysis shows that morbid obesity independently prognosticates adverse clinical outcomes in paediatric AP.
病态肥胖与成人急性胰腺炎（AP）的不良临床结局有关，并且具有促炎作用。肥胖在儿童中越来越普遍，因此，我们试图使用大型儿科人群队列来评估病态肥胖对 AP 临床结局的影响。
我们分析了 2003 年至 2016 年期间美国儿科住院患者数据库，其中包括使用特定的 ICD-9-CM 和 ICD-10-CM 编码诊断为 AP 的所有患者（年龄≤21 岁）。我们比较了无肥胖（对照组）和病态肥胖（病例组）儿童的临床结局。主要结局为严重 AP（2012 年亚特兰大修订分类），次要结局包括医疗资源利用（住院时间和住院费用）。
在 36698 例儿科 AP 住院患者中，有 1275 例（3.5%）被诊断为病态肥胖。从 2003 年到 2016 年，AP 患者中病态肥胖儿童的比例从 1.3%增加到 5.5%（P<0.001）。超过一半（54%）的病态肥胖儿童的病因是胆石症。病态肥胖儿童的严重 AP 患病率明显更高（7.3%比 3.8%，P<0.001）。多变量分析显示，病态肥胖与严重 AP 显著相关（OR 1.79，95%CI 1.4-2.26），住院时间延长（0.41 天，P=0.03），住院费用增加（1596 美元，P<0.001）。
与成人人群不同，儿童中没有其他混杂的合并症，这项全国性分析表明，病态肥胖独立预测儿科 AP 的不良临床结局。
