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.