Computed tomography derived morphomics in the prediction of long-term outcomes in acute pancreatitis

Acute pancreatitis is a common abdominal pathology with significant morbidity and mortality in select patients. Currently, prediction of outcome and prognosis in patients with acute pancreatitis is based on a variety of indices, scores, and criteria calculated from biochemical, clinical, and imaging parameters, but all currently available predictors of outcome have limitations. Analytic morphomics, a quantitative technique that assesses body composition from cross-sectional imaging, may offer a novel approach to outcome prediction.

To evaluate whether analytic morphomics-derived parameters can predict recurrence and mortality after an index episode of acute pancreatitis.

Following ethical approval, a retrospective single-centre study was conducted at Cork University Hospital. Adult patients presenting with acute pancreatitis between January 2012 and December 2013 were included and followed for 10 years. Patients with pancreatic malignancy, equivocal diagnoses, or age < 18 years were excluded. Cases of acute pancreatitis were classified as acute interstitial oedematous pancreatitis or necrotising pancreatitis. Demographic, biochemical, and clinical data were collected, including the modified Glasgow Imrie severity score. Computed tomography examinations were analysed using CoreSlicer for semi-automated segmentation of skeletal muscle and adipose tissue at the L3 vertebral level. Statistical analysis was performed using Microsoft Excel and Jamovi, including the Mann-Whitney U test, Pearson correlation, and logistic regression.

Seventy-two patients were included with a median modified Glasgow Imrie severity score of 2. Wall muscle (WM) density correlated inversely with disease severity [WM density (Hounsfield units): r = -0.480, P < 0.001; psoas muscle density (Hounsfield units): r = -0.465, P < 0.001]. Higher WM density and greater subcutaneous fat (SCF) area were associated with reduced 30-day mortality (mean difference 14.4 HU, P = 0.003; 65.3 cm², P = 0.033, respectively) and improved 10-year survival. On multivariate analysis, lower WM density and lower SCF area independently predicted short- and long-term mortality, while no morphomic variables were independently associated with recurrence.

Skeletal muscle quality and SCF are protective factors in acute pancreatitis. Integration of morphomics with existing severity scores may enhance prognostication. Larger studies are needed to validate these findings.