CAN BASELINE FRAILTY METRICS PREDICT OUTCOMES IN NECROTIZING PANCREATITIS?
Elliott Yee*, Andrew J. Sood, Thomas K. Maatman, Cameron Colgate, Nicholas J. Zyromski
Indiana University School of Medicine, Carmel, IN
Background: Acute necrotizing pancreatitis (NP) accounts for up to 20% of acute pancreatitis and is associated with significant morbidity and mortality. Frailty is a decrease in physiologic reserve resulting in increased vulnerability to acute physiologic stress; metrics include sarcopenia, malnutrition, and various frailty indices. Frailty in the setting of NP has not been previously studied. We hypothesized that baseline frailty may predict worse outcomes in patients with NP.
Methods: Clinical and radiographic records from a prospectively maintained, single-institution NP database were reviewed. Three frailty metrics were evaluated: 1) sarcopenia - measured by psoas muscle index [normalized to either patient height (PMI-H) or vertebral body area (PMI-VB)] and Hounsfield Unit Average Calculation (HUAC) from index computed-tomography images; 2) Prognostic Nutritional Index (PNI) measured nutritional status at disease onset with the formula 10 X albumin (g/dl) + 0.005 X total lymphocyte count (per mm3); and 3) a validated, ten criteria comorbidity-centric modified frailty index (mFI). Univariable and multivariable analysis measured the effect of frailty on organ failure, infected necrosis, step-up approach failure, total length of hospital stay, and mortality.
Results: A sample of 343 patients treated for NP at a single institution between 2011-2017 were studied. Most patients were male (65%). Biliary etiology of NP was most common (45%). The mean age at the onset of pancreatitis was 51 ± 15.3 years. The mean PMI-H, PMI-VB, and HUAC for males and females are shown in table 1. In multivariable analysis, lower PNI in males and lower HUAC in females predicted organ failure; lower PNI in both males and females predicted infected necrosis; lower PNI in males, lower HUAC and higher PMI-H in females were predictors of failed step-up approach (table 2). No frailty metric was associated with mortality or cumulative length of hospital stay. Lower overall PMI-VB was associated with increased need for repeated invasive intervention on Cox survival analysis (HR 1.30, p=0.015).
Conclusion: Baseline malnutrition and lower psoas muscle density are components of frailty that portend worse outcomes in NP.
Table 1. Mean values for PMI-H, PMI-VB, HUAC, and PNI by gender. 
Table 2. Multivariable predictors of organ failure, infected necrosis, and step-up approach failure.
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