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Tian CC, Hu C, Liu XY, Shen YY, Wu YM, Zhang LX, Mei Q. Body surface area-indexed residual pancreatic volume predicts early new-onset diabetes after acute necrotizing pancreatitis: Multivariable model evaluation. World J Gastroenterol 2027; 33(3): 124070 [DOI: 10.3748/wjg.124070]
World J Gastroenterol. Jan 21, 2027; 33(3): 124070 Published online Jan 21, 2027. doi: 10.3748/wjg.124070
Body surface area-indexed residual pancreatic volume predicts early new-onset diabetes after acute necrotizing pancreatitis: Multivariable model evaluation
Cheng-Cheng Tian, Cui Hu, Xing-Yu Liu, Yuan-Yuan Shen, Yu-Mei Wu, Li-Xue Zhang, Qiao Mei
Cheng-Cheng Tian, Cui Hu, Xing-Yu Liu, Yuan-Yuan Shen, Yu-Mei Wu, Li-Xue Zhang, Qiao Mei, Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Co-first authors: Cheng-Cheng Tian and Cui Hu.
Author contributions: Tian CC and Hu C contribute equally to this study as co-first authors; Mei Q is the corresponding author; Mei Q was the first to propose the study concept; Mei Q, Tian CC, and Hu C performed all clinical and data management procedures; Mei Q and Tian CC designed the research study; Tian CC, Hu C, Liu XY, and Shen YY performed the research; Tian CC, Wu YM, and Zhang LX analyzed the data; Tian CC and Hu C wrote the manuscript; Mei Q reviewed the paper; all authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Institutional review board statement: This study was conducted with approval from the Institutional Review Board and Ethics Committee of the First Affiliated Hospital of Anhui Medical University (approval No. PJ 2023-12-18).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study and the use of anonymized clinical data.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Qiao Mei, MD, PhD, Professor, Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui Province, China. meiqiao@ahmu.edu.cn
Received: June 5, 2026 Revised: June 26, 2026 Accepted: July 27, 2026 Published online: January 21, 2027 Processing time: 162 Days and 7 Hours
Abstract
BACKGROUND
New-onset diabetes (NOD) remains a major clinical challenge after acute necrotizing pancreatitis (ANP), and reliable early predictors are limited. Residual pancreatic volume (RPV) may reflect preserved endocrine function and help identify patients at high risk.
AIM
To investigate whether body surface area (BSA)-indexed RPV, measured on contrast-enhanced computed tomography (CECT) at 3-5 weeks after ANP onset, is associated with the risk of early NOD, and to determine its value in early risk stratification.
METHODS
Patients underwent CECT at 3-5 weeks after ANP onset, and RPV was manually measured and indexed to BSA. NOD was assessed at 3-6 months after ANP onset. Restricted cubic spline analysis, logistic regression, receiver operating characteristic analysis, and decision curve analysis were performed. We constructed three predictive models. Model 1 was based on RPV/BSA alone, model 2 additionally included age, and model 3 further adjusted for peak blood glucose and bedside index for severity in acute pancreatitis (BISAP) score.
RESULTS
A total of 170 ANP patients were included, with an early NOD incidence of 17.65% (30/170). RPV/BSA was significantly lower in the NOD group than in the non-NOD group (34.1 cm3/m2 vs 57.7 cm3/m2; P < 0.001). The only independent protective factor for early NOD in multivariable logistic regression analysis that controlled for age, peak blood glucose, and BISAP score was RPV/BSA (adjusted odds ratio = 0.524 per 10 cm3/m2 increase, P < 0.001). The model based on RPV/BSA alone yielded an area under the curve (AUC) of 0.814, with an optimal cutoff of 47.8 cm3/m2 (sensitivity 86.7%, specificity 68.6%); adding other variables did not significantly improve the AUC (P > 0.05). Decision curve analysis confirmed clinical net benefit for all three models, with the fully adjusted model 3 providing the highest yield.
CONCLUSION
RPV/BSA, as quantified on convalescent-phase CECT after ANP, was independently associated with reduced risk of early NOD and may serve as a practical imaging biomarker of pancreatic endocrine reserve. The best clinical utility for early detection of patients at high risk for early NOD was shown by the fully adjusted model 3.
Core Tip: Acute necrotizing pancreatitis (ANP) is often followed by new-onset diabetes (NOD), but reliable tools for early risk stratification are still lacking. We obtained body surface area-indexed residual pancreatic volume (RPV/BSA) from follow-up contrast-enhanced computed tomography performed during the convalescent phase of ANP, and determined NOD status at 3-6 months after disease onset. RPV/BSA exhibited a clear linear inverse relationship with early NOD and emerged as an independent protective factor. A combined model incorporating RPV/BSA, age, peak blood glucose, and bedside index for severity in acute pancreatitis score offered the best overall clinical performance for identifying patients at elevated risk of early NOD.
