S153 Association Between Obesity and Necrotizing Pancreatitis: A Nationwide Cohort Analysis

Introduction: Necrotizing pancreatitis represents a severe form of acute pancreatitis associated with high morbidity and resource utilization. Obesity is a rising global epidemic and has been implicated in worse outcomes and increased severity in acute pancreatitis. However, the independent association between obesity and the development of necrotizing pancreatitis remains poorly defined. Using a large, nationally representative inpatient database, we sought to quantify the relationship between obesity and necrotizing pancreatitis to better inform risk stratification. Methods: We analyzed adult hospitalizations (age ≥18 years) from the National Inpatient Sample (2018 to 2020). Necrotizing pancreatitis (with and without infection) and obesity were identified using ICD-10-CM diagnosis codes. Multivariable survey-weighted logistic regression was used to evaluate the association between obesity and necrotizing pancreatitis, adjusting for demographics, hospital characteristics, Charlson Comorbidity Index, age, sex, diabetes, hypertension, hyperlipidemia, smoking, and alcohol use. Results: A total of 2.1 million hospitalizations had acute pancreatitis, 70,410 had necrotizing pancreatitis without infection, and 20,430 had infected pancreatic necrosis. Obesity was significantly associated with higher odds of acute pancreatitis (odds ratio [OR]: 1.19, P < 0.001). Obesity significantly increased the odds of necrotizing pancreatitis with and without infection after adjusting for other covariates; in subgroup analyses, the OR was 1.22 (95% CI: 1.16–1.27; P < 0.001) for necrosis without infection and 1.22 (95% CI: 1.12–1.33; P < 0.001) for infected necrosis. Other variables significantly associated with necrotizing pancreatitis included alcohol use (OR 6.24), hypertension (OR 1.71) and diabetes (OR 1.64). Conclusion: Obesity was consistently associated with a 22% higher likelihood of developing necrotizing pancreatitis (both non-infectious and infected), indicating that excess adiposity may amplify pancreatic injury. Adipose-derived proinflammatory cytokines and impaired microcirculation likely contribute to more severe pancreatic necrosis. Clinically, obese patients with acute pancreatitis warrant earlier imaging and intensified monitoring to detect necrosis promptly. Although reliance on ICD-10 codes may misclassify obesity, these results underscore the importance of weight management and metabolic optimization to mitigate necrotizing complications.