Fatty Liver Disease and Non-Alcoholic Fatty Liver Disease Worsen the Outcome in Acute Pancreatitis: A Systematic Review and Meta-Analysis.

Péter Hegyi,Péter Hegyi,Péter Jeno Hegyi,Szilárd Váncsa,Adrienn Erős,Gabriella Pár,Adrienn Erős,Dávid Németh,Dániel Pécsi,Alexandra Mikó,Bálint Erőss,Zsolt Szakács

doi:10.3390/jcm9092698

Péter Hegyi, Péter Hegyi + Show 10 more

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https://doi.org/10.3390/jcm9092698

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The prevalence of fatty liver disease (FLD) and that of non-alcoholic fatty liver disease (NAFLD) share some risk factors known to exacerbate the course of acute pancreatitis (AP). This meta-analysis aimed to investigate whether FLD or NAFLD carry a higher risk of untoward outcomes in AP. In accordance with PRISMA guidelines, we performed a systematic search in seven medical databases for cohort studies that compared the outcomes of AP for the presence of FLD or NAFLD, and we calculated pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). We included 13 articles in our meta-analysis. AP patients with FLD were more likely to die (5.09% vs 1.89%, OR = 3.56, CI = 1.75–7.22), develop severe AP (16.33% vs 7.87%, OR = 2.67, CI = 2.01–3.56), necrotizing pancreatitis (34.83% vs 15.75%, OR = 3.08, CI = 2.44–3.90) and had longer in-hospital stay (10.8 vs 9.2 days, WMD = 1.46, OR = 0.54–2.39). Patients with NAFLD were more likely to have severe AP and longer hospital stay. Both FLD and NAFLD proved to be independent risk factors of a more severe disease course (OR = 3.68, CI = 2.16–6.29 and OR = 3.39, CI = 1.52–7.56 for moderate/ severe vs. mild AP, respectively). FLD and NAFLD worsen the outcomes of AP, which suggests that incorporating FLD or NAFLD into prognostic scoring systems of AP outcomes might improve the prediction of severity and contribute to a more individualized patient care.

Highlights

Fatty liver disease (FLD) is becoming increasingly common in the Western world, affecting about 25% of the population globally [1]
Four of the included articles suggested the incorporation of FLD into prognostic tools, but only Hao et al [27] analyzed the effect of inclusion of FLD in the APACHE-II score system
Our results showed that FLD and non-alcoholic fatty liver disease (NAFLD) worsen the course of Acute pancreatitis (AP)

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Introduction

Fatty liver disease (FLD) is becoming increasingly common in the Western world, affecting about 25% of the population globally [1]. FLD is a clinicopathologic entity with a histological spectrum that includes simple steatosis and steatohepatitis, it encompasses a broad variety of etiology. The most common causes of FLD are non-alcoholic fatty liver disease (NAFLD) associated with metabolic syndrome (MetS), alcohol abuse alone or in association with hypertriglyceridemia, and the combination of the causes above. It is widely known that there is a bidirectional association between NAFLD and components of MetS [2]. The presence of NAFLD increases the risk of cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, liver cirrhosis, and liver cancer [3]. Acute pancreatitis (AP) is a common acute gastrointestinal disease, posing a substantial social and economic burden [4]. The mortality of AP has been decreasing in the past decades, it is still between 2–5% and it remains high, up to 15–25% in subgroups of patients with severe AP, depending on the extent of necrosis and systemic complications [5]

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