Published in:
01-06-2014 | Original Article
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
Published in: Digestive Diseases and Sciences | Issue 6/2014
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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/m2], overweight (BMI = 23–24.9 kg/m2) and obese (BMI > 25 kg/m2), 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/m2 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.