Li Y, Zheng KY, Liu ZL, Yu TM, Zhang WJ, Zhong MW, Hu SY. Perirenal fat area is a preoperative predictor of hypertension resolution after laparoscopic sleeve gastrectomy: Generalized additive models. World J Gastroenterol 2025; 31(12): 104952 [DOI: 10.3748/wjg.v31.i12.104952]
Corresponding Author of This Article
San-Yuan Hu, MD, Chief Physician, Professor, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan 250012, Shandong Province, China. husanyuan1962@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yue Li, Zeng-Lin Liu, Department of General Surgery, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250014, Shandong Province, China
Kai-Yuan Zheng, Wen-Jie Zhang, Ming-Wei Zhong, Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
Tian-Ming Yu, San-Yuan Hu, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Li Y, Zhang WJ, and Hu SY participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Li Y wrote the manuscript; Zheng KY, Liu ZL, Yu TM, and Zhang WJ accessed and verified the study data. All authors critically reviewed and provided final approval of the manuscript; and all authors were responsible for the decision to submit the manuscript for publication.
Supported by the National Natural Science Foundation of China, No. 82270914 and No. 82401043.
Institutional review board statement: This investigation was approved by the Institutional Ethics Committee of Shandong Qianfoshan Hospital, No. 2025(S002).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: San-Yuan Hu, MD, Chief Physician, Professor, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan 250012, Shandong Province, China. husanyuan1962@hotmail.com
Received: January 10, 2025 Revised: February 16, 2025 Accepted: February 28, 2025 Published online: March 28, 2025 Processing time: 75 Days and 0.8 Hours
Abstract
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) can lead to complete resolution of hypertension in most patients with obesity within one year. However, the preoperative factors related to this resolution are still unclear.
AIM
To clarify the impact of relevant factors, particularly perirenal fat, on postoperative hypertension resolution.
METHODS
In this retrospective single-center study, a total of 138 patients with obesity and hypertension were included, all of whom underwent LSG in the hospital and were followed up for one year. Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution. Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution, and their predictive values were compared using fivefold cross-validation.
RESULTS
After LSG, 107 patients (77.5%) experienced hypertension resolution, while 31 patients (22.5%) did not achieve resolution. Both the preoperative perirenal fat area (PrFA) and perirenal fat thickness were independent risk factors for postoperative hypertension resolution (P < 0.001 vs P = 0.002). These factors are curvilinearly correlated with the hypertension resolution rate, but PrFA has a better predictive value than perirenal fat thickness dose (area under the curve = 0.846 vs 0.809). Compared with those with PrFA ≥ 18 cm2, patients with PrFA < 18 cm2 had a higher hypertension resolution rate [87% vs 68.1%; odds ratio (95% confidence interval) = 3.513 (1.367-9.902), P = 0.012].
CONCLUSION
PrFA is a preoperative predictor of postoperative hypertension resolution. It is curvilinearly associated with the resolution rate, and patients with PrFA < 18 cm² have better hypertension resolution outcomes after LSG.
Core Tip: In this retrospective single-center study, we found that the preoperative perirenal fat area (PrFA), an important factor linking obesity and hypertension, is an independent predictor of hypertension resolution after laparoscopic sleeve gastrectomy. Particularly, PrFA could achieve an accuracy of approximately 85% in predicting resolution using the generalized additive model. Based on the curvilinear correlation between PrFA and resolution rate, we set 18 cm2 as the cutoff value for PrFA and found that patients with PrFA < 18 cm2 had a higher hypertension resolution rate than those with PrFA ≥ 18 cm2 [87% vs 68.1%; odds ratio (95% confidence interval) = 3.513 (1.367-9.902), P = 0.012].
