High risk of complications and acute-on-chronic liver failure in cirrhosis patients with acute pancreatitis

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

“…In this issue of the Journal, Vogel et al report that acute pancreatitis runs a more severe course in case of coexistent liver cirrhosis [7]. In their retrospective monocenter study, all 52 cirrhotic patients admitted for acute pancreatitis between 2011 and 2020 (3.5% of all acute pancreatitis patients in their database) were compared to 104 patients without cirrhosis admitted with acute pancreatitis (1:2 matched-pair analysis).…”

“…It should be noted that the cirrhosis patients that were included in this study had relatively advanced disease with a median MELD score of 16. The publication of Vogel et al [7] is timely and interesting since previous available literature is scarce. Another recent smaller retrospective single-center study [8] compared 40 cirrhotic patients with acute pancreatitis (4.9% of all patients with acute pancreatitis in their database) with 80 non-cirrhotic acute pancreatitis patients (selected by 1:2 propensity score matching).…”

“…Several limitations apply to the publication by Vogel et al [7]. Due to the retrospective design there is an inevitable risk of bias.…”

“…According to a recent nationwide prospective multicenter randomized controlled trial in the Netherlands [5], postponing drainage could lead to more successful conservative management, with a reduced need for re-interventions. Although it remains to be seen whether such policy is generalizable to a population of patients with acute pancreatitis and cirrhosis, it may well be that an approach with preference for late interventions could have led to better results in the study of Vogel et al [7]. Another example that treatment in the study of Vogel et al [7] was not always according to current insights [2], are the high numbers of early ERCP (performed in 70-80% of patients with suspected biliary cause in both groups, with more procedural complications in the cirrhotic group).…”

“…Although it remains to be seen whether such policy is generalizable to a population of patients with acute pancreatitis and cirrhosis, it may well be that an approach with preference for late interventions could have led to better results in the study of Vogel et al [7]. Another example that treatment in the study of Vogel et al [7] was not always according to current insights [2], are the high numbers of early ERCP (performed in 70-80% of patients with suspected biliary cause in both groups, with more procedural complications in the cirrhotic group). Finally, the multivariable analyses in this report are not in line with the recommendations for etiological research versus prediction research [12,13], resulting in limited interpretability and applicability of the data.…”