Effect of insulin resistance on the severity of acute pancreatitis

Abstract

Background and Aims: Acute pancreatitis is inflammation of the pancreas due to various causes. Insulin resistance is an important component of the metabolic syndrome and causes a chronic inflammatory condition, so it may affect disease severity in acute pancreatitis patients. In our study, we aimed to investigate the relationship of insulin resistance with acute pancreatitis severity and to compare it with other prognostic factors. Materials and Methods: In our study, 84 patients hospitalized in the clinic with a diagnosis of acute pancreatitis were evaluated. Our study was designed prospectively. To determine the severity of acute pancreatitis, the Atlanta Classification, Bedside Index of Severity in Acute Pancreatitis score, Imrie score, Ranson score, and Balthazar score were determined using the laboratory and imaging findings of the patients. The 'Homeostasis Model Assessment of Insulin Resistance' score was used to evaluate insulin resistance in patients. Accordingly, it was investigated whether there was a difference between the groups with and without insulin resistance in terms of disease severity. Results: 45.2% of the patients were in the group with insulin resistance. According to the Atlanta classification, 6 patients (7.1%) were evaluated as severe acute pancreatitis. 4 patients were evaluated as severe acute pancreatitis because of the development of prerenal acute kidney injury and 2 patients due to sepsis and need for intensive care. In the Receiver Operating Characteristic analysis performed in terms of disease severity, Balthazar and the 'Bedside Index of Severity in Acute Pancreatitis' score were found to be strong in determining the prognosis of the patients (Area Under the Curve; 0.955 and 0.979, respectively). When the 'Bedside Index of Severity in Acute Pancreatitis' and Balthazar scores of the group with insulin resistance were compared with the group without insulin resistance, a statistically significant difference was found (p = 0.019 and p = 0.013, respectively). Conclusion: The high 'Bedside Index of Severity in Acute Pancreatitis' and Balthazar scores in our study in acute pancreatitis patients with insulin resistance suggest that the presence of insulin resistance can be used as a prognostic factor for severe acute pancreatitis.