The degree of obesity correlates with the severity of acute pancreatitis: An international multicenter cohort analysis of 2244 patients

INTRODUCTION: Acute pancreatitis (AP) is a potentially severe or fatal gastrointestinal disease. Obesity is a major risk factor for chronic comorbidities and for a worse outcome in acute inflammatory conditions. We aimed to investigate the characteristics and role of the degree of obesity in the course and outcome of AP. METHODS: In total, 2244 AP cases from 13 countries and 29 centers of the Acute Pancreatitis Registry run by the Hungarian Pancreatic Study Group were included in our analysis. Patient groups were formed based on body mass index (BMI) categories according to the World Health Organization definitions. Anamnestic, admission, and outcome parameters were analyzed. We used logistic regression and multivariable logistic regression to model the relationship between BMI and AP outcomes. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: In our cohort, 2.8% of patients were underweight, 30.0% normal, 35.0% overweight, and 20.0%, 8.2%, and 3.7% were in the obesity class I, II, and III groups. Examining the graded association in a multivariable logistic regression model, we found that the odds of organ failure increase with the degree of obesity (obesity class I: OR = 2.12, CI:1.29-3.46, p = 0.003; obesity class II: OR = 2.57, CI:1.40-4.71, p = 0.002; obesity class III: OR = 2.71, CI:1.25-5.89, p = 0.012). The three obesity groups had higher odds for severe AP as well (OR = 3.16, CI:1.71-5.83, p < 0.001; OR = 3.98, CI:1.95-8.15, p < 0.001; OR = 2.80, CI:1.05-7.48, p = 0.040, respectively). CONCLUSION: Obesity dose-dependently elevates the odds of pre-existing comorbidities and complications. Gradual weight loss may also have a positive effect and the impact of patient education should be investigated.