Sarcopenia is associated with an unfavorable outcome in patients with acute pancreatitis: A propensity score analysis

BACKGROUND: Sarcopenia and age are risk factors for poor outcomes in acute pancreatitis (aP). However, the role of sarcopenia independent of patients' age remains unclear, and assessment methods vary. AIMS: This study assessed sarcopenia, using the Hounsfield unit average calculation (HUAC) for the psoas muscle, and its impact on aP outcomes, independent of other risk factors. METHODS: 208 aP patients who received early computed tomography (CT) were classified as sarcopenic or non-sarcopenic based on HUAC. Propensity score matching (PSM) reduced heterogeneity. Clinical outcomes and independent predictors of intensive care unit (ICU) admission were determined by multivariable logistic regression. RESULTS: After PSM, sarcopenic patients (n = 53) had longer hospital (24.9 ± 20.6d vs. 18.2 ± 27.3d; p = 0.0006) and ICU stays (9.5 ± 16.5d vs. 6.2 ± 25.8d; p = 0.0077) than non-sarcopenic patients (n = 53). ICU admission was more frequent (58.5 % vs. 37.7 %; p = 0.0325), and aP-associated morbidity such as pleural effusion occurred more often (p = 0.0019). Independent predictors of ICU admission included pleural effusion or ascites (p = 0.0116) and impaired coagulation (p = 0.0365). CONCLUSION: Sarcopenia identified via HUAC in early aP is associated with a worse clinical outcome. Pleural effusion or ascites and changes in blood coagulation independently predict ICU admission in sarcopenic aP patients. Early nutritional and physical therapy should be considered to prevent and treat sarcopenia in aP patients.