Abstract：
BACKGROUND: Given the previously reported harmful effects of abdominal fat burden on kidney function, we aim to investigate the relationship between major adverse kidney events within 30 days (MAKE30) and abdominal obesity in acute necrotizing pancreatitis (ANP) patients and explore the underlying risk factors.
METHODS: A retrospective cohort study of all patients admitted within 72 h after the first episode of ANP to a tertiary center between June 2015 and June 2019 was conducted. Automatic image analysis software was used to calculate the area of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and skeletal muscle from computed tomography scans at the umbilical level. The potential risk factors of MAKE30 were analyzed by logistic regression.
RESULTS: A total of 208 eligible ANP patients were enrolled, with an incidence of 23% for MAKE30. VAT area was more closely associated with the development of MAKE30, with an area under the ROC curve of 0.69 (cutoff value 200 cm2, 63.8% sensitivity and 66.7% specificity). Multivariate logistic regression analysis demonstrated that VAT area [OR 1.01 (1.01-1.02); p < 0.001] was an independent risk factor in predicting MAKE30. Patients with a VAT area > 200 cm2 had more requirements of renal replacement therapy (32% vs. 12%, P < 0.001), and a significantly higher incidence of other poor clinical outcomes (all p < 0.05).
CONCLUSIONS: Early assessment of the VAT area may help identify ANP patients at high risk of MAKE30, suggesting that it could be a potential indicator for adverse kidney events.
METHODS: A retrospective cohort study of all patients admitted within 72 h after the first episode of ANP to a tertiary center between June 2015 and June 2019 was conducted. Automatic image analysis software was used to calculate the area of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and skeletal muscle from computed tomography scans at the umbilical level. The potential risk factors of MAKE30 were analyzed by logistic regression.
RESULTS: A total of 208 eligible ANP patients were enrolled, with an incidence of 23% for MAKE30. VAT area was more closely associated with the development of MAKE30, with an area under the ROC curve of 0.69 (cutoff value 200 cm2, 63.8% sensitivity and 66.7% specificity). Multivariate logistic regression analysis demonstrated that VAT area [OR 1.01 (1.01-1.02); p < 0.001] was an independent risk factor in predicting MAKE30. Patients with a VAT area > 200 cm2 had more requirements of renal replacement therapy (32% vs. 12%, P < 0.001), and a significantly higher incidence of other poor clinical outcomes (all p < 0.05).
CONCLUSIONS: Early assessment of the VAT area may help identify ANP patients at high risk of MAKE30, suggesting that it could be a potential indicator for adverse kidney events.
摘要：
背景：鉴于先前报道的腹部脂肪负担对肾功能的有害影响，我们旨在研究急性坏死性胰腺炎(ANP)患者30天内主要肾脏不良事件(MAKE30)与腹型肥胖的关系,并探讨其潜在危险因素.
方法：对2015年6月至2019年6月在三级中心首次发生ANP后72小时内收治的所有患者进行回顾性队列研究。采用自动图像分析软件计算皮下脂肪组织面积(SAT),内脏脂肪组织（VAT）和骨骼肌的计算机断层扫描在脐带水平。采用logistic回归分析MAKE30的潜在危险因素。
结果：共纳入208名合格的ANP患者，MAKE30的发病率为23%。VAT面积与MAKE30的发展更密切相关，ROC曲线下面积为0.69（截止值200cm2，灵敏度63.8％，特异性66.7％）。多因素logistic回归分析显示,VAT面积[OR1.01(1.01-1.02);p<0.001]是预测MAKE30的独立危险因素。VAT面积>200cm2的患者需要更多的肾脏替代疗法（32％vs.12%,P<0.001)，以及其他不良临床结局的发生率显着升高（均p<0.05）。
结论：对VAT区域的早期评估可能有助于识别MAKE30高风险的ANP患者，这表明它可能是不良肾脏事件的潜在指标。
方法：对2015年6月至2019年6月在三级中心首次发生ANP后72小时内收治的所有患者进行回顾性队列研究。采用自动图像分析软件计算皮下脂肪组织面积(SAT),内脏脂肪组织（VAT）和骨骼肌的计算机断层扫描在脐带水平。采用logistic回归分析MAKE30的潜在危险因素。
结果：共纳入208名合格的ANP患者，MAKE30的发病率为23%。VAT面积与MAKE30的发展更密切相关，ROC曲线下面积为0.69（截止值200cm2，灵敏度63.8％，特异性66.7％）。多因素logistic回归分析显示,VAT面积[OR1.01(1.01-1.02);p<0.001]是预测MAKE30的独立危险因素。VAT面积>200cm2的患者需要更多的肾脏替代疗法（32％vs.12%,P<0.001)，以及其他不良临床结局的发生率显着升高（均p<0.05）。
结论：对VAT区域的早期评估可能有助于识别MAKE30高风险的ANP患者，这表明它可能是不良肾脏事件的潜在指标。
