Department of Surgery, Indiana University School of Medicine and Indiana University Health, 545 Barnhill Dr., Emerson Hall 519, Indianapolis, IN, 46202, USA.
Department of Surgery, Eastern Health, St. Johns, NL, Canada.
J Gastrointest Surg. 2022 Oct;26(10):2128-2135. doi: 10.1007/s11605-022-05383-0. Epub 2022 Aug 12.
Obesity is epidemic in the USA. Limited data exist examining obesity's influence on necrotizing pancreatitis (NP) disease course.
Retrospective review of prospectively maintained database of 571 adult necrotizing pancreatitis patients treated between 2007 and 2018. Patients were grouped according to body mass index (BMI) at disease onset. Patient characteristics, necrotizing pancreatitis course, and outcomes were compared between non-obese (BMI < 30) and obese (BMI > 30) patients.
Among 536 patients with BMI data available, 304 (57%) were obese (BMI > 30), and 232 (43%) were non-obese (BMI < 30). NP etiology in the obese group was more commonly biliary (55% versus 46%, p = 0.04) or secondary to hypertriglyceridemia (10% versus 2%, p < 0.001) and less commonly alcohol (17% versus 26%, p = 0.01). Obese patients had a higher incidence of baseline comorbid disease. The CT severity index was similar between groups though obese patients had a higher rate of > 50% pancreatic gland necrosis (27% versus 19%, p = 0.02). The rates of infected necrosis and organ failure were higher among obese patients. Percutaneous drainage was more common in obese patients. Time to first necrosis intervention was earlier with increasing BMI. NP disease duration was longer in obese patients. The overall mortality rate of non-obese and obese patients did not differ. However, mortality rate increased with increasing BMI.
Necrotizing pancreatitis in obese patients is characterized by a prolonged disease course, a higher risk of organ failure, infected necrosis, and the need for early necrosis-related intervention. Mortality increases with increasing BMI.
肥胖在美国是一种流行疾病。目前，关于肥胖对坏死性胰腺炎（NP）病程影响的数据有限。
回顾性分析了 2007 年至 2018 年间收治的 571 例成人坏死性胰腺炎患者的前瞻性数据库。根据发病时的体重指数（BMI）将患者分为两组。比较非肥胖（BMI<30）和肥胖（BMI>30）患者的患者特征、坏死性胰腺炎病程和结局。
在 536 例有 BMI 数据的患者中，304 例（57%）为肥胖（BMI>30），232 例（43%）为非肥胖（BMI<30）。肥胖组 NP 的病因更常见于胆源性（55%比 46%，p=0.04）或继发于高三酰甘油血症（10%比 2%，p<0.001），而较少见于酒精性（17%比 26%，p=0.01）。肥胖患者基线合并症的发生率更高。两组的 CT 严重程度指数相似，但肥胖患者>50%胰腺坏死的发生率更高（27%比 19%，p=0.02）。肥胖患者感染性坏死和器官衰竭的发生率更高。肥胖患者更常进行经皮引流。随着 BMI 的增加，首次坏死干预的时间更早。肥胖患者 NP 病程较长。非肥胖和肥胖患者的总死亡率没有差异。然而，死亡率随着 BMI 的增加而增加。
肥胖患者的坏死性胰腺炎病程较长，器官衰竭风险较高，感染性坏死发生率较高，需要早期进行坏死相关干预。死亡率随 BMI 增加而增加。
