Role of Visceral Adipose Tissue in Predicting the Prognosis of Acute Pancreatitis: A Tertiary Level Hospital-Based Study From Chennai

BACKGROUND: Acute pancreatitis (AP) ranges clinically from mild, self-limiting inflammation to severe disease with multi-organ failure. Visceral adipose tissue (VAT), a key contributor to systemic inflammation and metabolic dysfunction, may therefore influence AP severity, yet its prognostic value in the Indian population remains limited in the literature. AIM: The aim of this study is to assess whether VAT and the VAT/SMT (skeletal muscle tissue) ratio can predict clinical severity and short-term prognosis of AP in a tertiary care hospital in Chennai. MATERIALS AND METHODS: This cross-sectional study included 62 patients aged 18-60 years diagnosed with AP at ACS Medical College and Hospital from December 2023 to February 2025. Contrast-enhanced CT scans obtained within 24 hours were used to quantify VAT, subcutaneous adipose tissue, SMT, and VAT/SMT ratios at the L3-L4 vertebral level. Severity grading was performed using APACHE II (Acute Physiology and Chronic Health Evaluation), modified computed tomography severity index (MCTSI), and the Revised Atlanta Classification. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States). RESULTS: Higher VAT values and elevated VAT/SMT ratios showed significant associations with increased APACHE II and MCTSI scores (p 180 cm² and VAT/SMT >1.5 exhibited more severe disease patterns. The MCTSI demonstrated strong concordance with the Revised Atlanta Classification. Male sex with alcohol consumption was significantly associated with higher severity, while age showed no significant impact. CONCLUSION: CT-derived VAT and VAT/SMT ratios are useful early markers associated with increased severity. Integrating CT-based VAT assessment with the MCTSI may enhance early risk stratification and guide timely clinical management.