Impact of body overweight and class I, II and III obesity on the outcome of acute biliary pancreatitis.

Objectives: Body overweight and obesity have been associated with an increased morbidity in acute pancreatitis, but conflicting results were reported in the literature with regard to the type and frequency of complications. We investigated the occurrence of complications in different classes of overweight in a homogeneous group of patients with gallstone pancreatitis.

Methods: Data were collected prospectively from 250 patients with biliary pancreatitis to allow calculation of the Blamey (Glasgow) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores. According to their body mass index (BMI), the patients were allocated to different categories of body overweight. The outcome for each category was measured by the components of the Atlanta criteria. Secondary end points of the study were the length of hospital stay, the length of stay at the intensive care unit, and the number of abdominal operations.

Results: When compared with normal-weight patients (BMI 18.5-24.9), all categories with BMI > or =25 had an increased risk of developing the "severe" form of acute pancreatitis [odds ratio (OR): 3.55, 95% confidence interval (CI): 1.50-8.40]. Patients with class I obesity (BMI 30-34.9) developed significantly more organ failure and local complications (OR: 3.469, 95% CI: 1.15-10.43). Patients with class II and III obesity (BMI 35-49.9) had, in addition to more organ failure and local complications, also more metabolic complications (OR: 7.33, 95% CI: 1.62-33.24) than did their normal-weight counterparts. They needed also more frequently intensive care and had a longer total hospital stay.

Conclusion: In acute biliary pancreatitis, body overweight and obesity represent a risk of more "severe" disease and the number and type of complications increase in categories of increasing BMI.