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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

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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/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.

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Correspondence to Rakesh Kochhar.

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Thandassery, R.B., Appasani, S., Yadav, T.D. et al. 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. Dig Dis Sci 59, 1316–1321 (2014). https://doi.org/10.1007/s10620-013-3000-7

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  • DOI: https://doi.org/10.1007/s10620-013-3000-7

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