High visceral adiposity and low skeletal muscle mass independently predict the development of acute cholecystitis in patients with gallstones: a retrospective cohort study.

BACKGROUND

While cholelithiasis is common, predicting which patients will develop acute cholecystitis (AC) remains a clinical challenge, as traditional risk factors like Body Mass Index (BMI) lack specificity. This study aimed to determine if CT-derived visceral adiposity and sarcopenia can predict the transition from asymptomatic cholelithiasis to clinical AC.

METHODS

This retrospective cohort study included 622 adult patients with cholelithiasis, identified via CT scans performed between 2015 and 2025. Patients were divided into an AC group (n = 164), who developed AC during follow-up, and a control group (n = 458) who did not. Body composition metrics, including visceral fat area (VFA) and skeletal muscle index (SMI), were quantified from axial CT images at the L3 vertebral level. A multivariate logistic regression analysis was performed to identify independent predictors of developing AC.

RESULTS

The AC group had significantly higher VFA and lower SMI compared to the control group. Multivariate analysis identified several independent predictors for developing AC, including hypertension (OR: 2.71, p < 0.001), hyperlipidemia (OR: 2.88, p < 0.001), and a 10 cm2 increase in VFA (OR: 1.34, p < 0.001). In contrast, a per-unit increase in SMI was found to be protective (OR: 0.94, p = 0.001). The predictive model demonstrated strong discriminatory power with an Area Under the Curve (AUC) of 0.857.

CONCLUSION

Visceral adiposity and sarcopenia are strong, independent predictors of the development of AC. These findings suggest that AC is a complication of a systemic metabolic state and that CT-based body composition analysis is a valuable tool for risk stratification in patients with cholelithiasis.