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

Abstract

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.

The Possible Association of Non-Alcoholic Fatty Liver Disease with Acute Cholangitis: A Retrospective Multicenter Cohort Study

“…As NAFLD is a modifiable risk factor, this life-threatening association of cholangitis merits concern, as treating NAFLD could probably reduce the prevalence of cholangitis in these patients. Notably, a recent systematic review with the meta-analysis by Váncsa et al reached the conclusion that NAFLD worsens the outcome of acute pancreatitis and suggested incorporating it into prognostic scores of acute pancreatitis outcome [25]. However, in our study, NAFLD was not associated with the severity of cholangitis.…”

Ketogenesis acts as an endogenous protective programme to restrain inflammatory macrophage activation during acute pancreatitis

“…Recent evidence suggests that the presence of comorbid liver metabolic syndrome predisposes AP patients to SAP and higher mortality. 60 , 61 , 62 In addition, hypertriglyceridaemia is a well-established metabolic disorder and increasing aetiology for AP that is more virulent than other aetiologies. 63 However, as a metabolic hub organ, the liver is common albeit overlooked in current experimental and human AP.…”

Variations in Gut Microbiome are Associated with Prognosis of Hypertriglyceridemia-Associated Acute Pancreatitis

“…The specific mechanisms by which hyperglycemia exacerbates AP remain unclear, and the most widely accepted explanation is that excessive production of free fatty acids leads to oxidative stress, vascular endothelial injury, pancreatic necrosis, and systemic inflammatory response [ 10 , 38 ]. Besides, HTGAP patients were more likely to be accompanied with fatty liver when compared with non-HTGAP patients, and previous studies found that fatty liver probably aggravated AP through the peroxisome proliferator activated receptor alpha (PPARα) signaling pathway and fatty acid degradation pathway [ 39 , 40 ].…”