Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis

Abstract

The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption, hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP). The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012 and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures, intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length of hospital stay, pseudocyst, fluid collection and systematic inflammatory response syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55–4.65 and 2.22–4.01, respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR = 1.72 and 1.50, 95% CI 1.04–2.84 and 0.96–2.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08–2.30). Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. Furthermore, AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed on determining aetiology on admission.

A Practical Approach to Management of Acute Pancreatitis: Similarities and Dissimilarities of Disease in Children and Adults

“…Given the current viewpoint of shared disease models of inflammation and recovery, treatment recommendations are equivalent. However, emerging data on how drugs [34,35] and ERCP [36,37] induce pancreatic inflammation and affect tissue regeneration are highlighting new ways in which we may be able to design etiologyspecific AP risk models as well as treatments rather than a one size fits all approach [38].…”

Risk Factors for Recurrent Pancreatitis After First Episode of Acute Pancreatitis

“…As is known to all that factors that can lead to AP are more likely to become causes of RAP. 9,29 It is essential to determine the etiology of the disease in time to apply the most appropriate therapy.…”

The Evolving Story of Multifactorial Chylomicronemia Syndrome

“…The presence of TG-rich lipoprotein remnants in circulation, which can penetrate the vascular wall, as well as the concomitant presence of atherogenic comorbidities such as obesity or diabetes, could explain the increased cardiovascular risk, whereas the exact mechanisms linking HTG and AP still remain poorly understood ( 12 – 14 ). However, patients with HTG generally present a more severe clinical course of AP, with increased morbidity and mortality ( 15 , 16 ).…”