43 Non-Alcoholic Fatty Liver Disease (NAFLD) Is Associated With Severe Acute Pancreatitis (SAP)

Abstract

INTRODUCTION: Approximately 15 to 25 percent of patients with AP go on to develop severe AP (SAP) with mortality rising up to 20% as this transition happens. This underlies the significance of identifying predictors of deterioration to SAP. The pancreas is often spared from hepatic disorders, however in non-alcoholic fatty liver disease (NFALD), the pancreas can also be involved mainly through pancreatic peripancreatic fat deposition. We hypothesized that increased fat deposition in and around the pancreas would lead to increased severity of AP. Therefore, we have performed a comprehensive systematic review and meta-analysis to we evaluate NAFLD's association to SAP. METHODS: A systematic review was conducted in Pubmed, EMBASE, and Cochrane databases from inception through April 2018 to identify studies which explored the correlation between NAFLD and SAP was conducted. Conference abstracts, review papers, non-english papers and unrelated papers were excluded. Relevant data were collected and analyzed using comprehensive meta-analysis software. Publication bias was assessed for using Egger's test. RESULTS: 4 case-controls studies examining a total of 4349 patients were included in our analysis. 31.8% of patients with acute pancreatitis were found to have NAFLD. The odds ratio (OR) of SAP in NAFLD compared to non-NAFLD was 2.57 (CI95% 2.15–3.06). No publication bias was noted using Egger's test. CONCLUSION: We note NAFLD to be found in about 31.8% of patients presenting with AP. Patients with NAFLD were significantly more likely to develop SAP than controls with OR 2.57 (CI95% 2.15–3.06) indicating a predisposition for SAP in this patient population. While this increase in SAP is likely related to increased pancreatic and peripancreatic fat deposition in NAFLD patients, further research is needed to determine the exact pathophysiology behind this association.