Highlights
- •NAFLD is the most common chronic liver disease today.
- •NAFLD is closely related to metabolic syndrome.
- •Presence of NAFL at admission can indicate a higher risk for developing more severe forms of AP.
- •Presence of NAFLD could be used as an additional prognostic tool for AP.
Abstract
Aim
To explore the effect of nonalcoholic fatty liver as a hepatic manifestation of metabolic
syndrome on the severity of acute pancreatitis. We hypothesized that patients with
nonalcoholic fatty liver would have a more severe form of acute pancreatitis.
Patients and methods
We retrospectively analyzed 822 patients hospitalized with acute pancreatitis. We
diagnosed acute pancreatitis and determined its severity according the revised Atlanta
classification criteria from 2012. We assessed nonalcoholic fatty liver with computed
tomography.
Results
There were 198 (24.1%) patients out of 822 analyzed who had nonalcoholic fatty liver.
Patients with nonalcoholic fatty liver had statistically higher incidence of moderately
severe (35.4% vs. 14.6%; p = 0.02) and severe acute pancreatitis (20.7% vs. 9.6%; p < 0.001) compared to patients without nonalcoholic fatty liver. At the admission patients
with nonalcoholic fatty liver had higher values of C-reactive protein as well as at
day three, higher APACHE II score at admission and significantly higher incidence
of organ failure and local complications as well as higher values of computed tomography
severity index compared to patients without nonalcoholic fatty liver. We found independent
association between the occurrence of moderately severe and severe acute pancreatitis
and nonalcoholic fatty liver (OR 2.13, 95%CI 1.236–3.689). Compared to patients without
nonalcoholic fatty liver, patients with nonalcoholic fatty liver had a higher death
rate, however not statistically significant (5.6% vs. 4.3%; p = NS).
Conclusion
Presence of nonalcoholic fatty liver at admission can indicate a higher risk for developing
more severe forms of acute pancreatitis and could be used as an additional prognostic
tool.
Keywords
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References
- Comparison of APACHE II and Imrie scoring systems in predicting the severity of acute pancreatitis.World J Emerg Surg. 2007; 2: 33
- Prognosis in acute pancreatitis.CMAJ. 2011; 183: 673-677
- Acute pancreatitis: diagnosis, prognosis, and treatment.Am Fam Physician. 2007; 75: 1513-1520
- Etiological and prognostic factors in human acute pancreatitis: a review.Am J Gastroenterol. 1982; 77: 633-638
- Prognostic factors in acute pancreatitis.Gut. 1984; 25: 1340-1346
- APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.Crit Care Med. 1981; 9: 591-597
- Acute pancreatitis: value of CT in establishing prognosis.Radiology. 1990; 174: 331-336
- Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus.Gut. 2013; 62: 102-111
- Nonalcoholic steatohepatitis: emerging targeted therapies to optimize treatment options.Drug Des Devel Ther. 2015; 9: 4835-4845
- Metabolic syndrome and acute pancreatitis.Eur J Intern Med. 2016; 32: 79-83
- Influence of fatty liver on the severity and clinical outcome in acute pancreatitis.PLoS One. 2015; 10e0142278
- Influence of obesity on the severity and clinical outcome of acute pancreatitis.Gut Liver. 2011; 5: 335-339
- Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome.World J Gastroenterol. 2005; 11: 6049-6052
- Imaging lexicon for acute pancreatitis: 2012 Atlanta Classification revisited.Gastroenterol Rep (Oxf). 2016; 4: 16-23
- The utility of radiological imaging in nonalcoholic fatty liver disease.Gastroenterology. 2002; 123: 745-750
- Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis.Hepatology. 2011; 54: 1082-1090
- Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal.J Hepatol. 2013; 58: 1007-1010
- Epidemiological modifiers of non-alcoholic fatty liver disease: focus on high-risk groups.Dig Liver Dis. 2015; 47: 997-1006
- The role of IL-6, 8, and 10, sTNFr, CRP, and pancreatic elastase in the prediction of systemic complications in patients with acute pancreatitis.Gastroenterol Res Pract. 2013; 2: 282645
- Role of pancreatic fat in the outcomes of pancreatitis.Pancreatology. 2014; 14: 403-408
- Association of fatty liver disease with nonfatal cardiovascular events in patients undergoing maintenance hemodialysis.Nephron Clin Pract. 2013; 124: 218-223
- Carotid intima-media thickness and liver histology in hemodialysis patients with nonalcoholic fatty liver disease.Int J Angiol. 2011; 20: 149-156
- Non-alcoholic fatty liver disease and increased risk of cardiovascular disease.Atherosclerosis. 2007; 191: 235-240
- Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease.Hepatology. 2005; 42: 473-480
- Presence of coronary plaques in patients with nonalcoholic fatty liver disease.Radiology. 2010; 254: 393-400
- Non alcoholic fatty liver disease: a manifestation of metabolic syndrome.Cleve Clin J Med. 2008; 75: 721-728
- Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.Aliment Pharmacol Ther. 2011; 33: 525-540
- Nonalcoholic fatty liver disease and its association with cardiovascular disease.Ann Hepatol. 2009; 8: S40-S43
- Kupffer cell depletion protects against the steatosis, but not the liver damage, induced by marginal copper, high fructose diet in male rats.Am J Physiol Gastrointest Liver Physiol. 2015; ([ajpgi.00285.2014. [Epub ahead of print]])
- Nonalcoholic fatty liver disease is associated with benign gastrointestinal disorder.World J Gastroenterol. 2013; 19: 8301-8311
Article info
Publication history
Published online: November 05, 2016
Accepted:
October 25,
2016
Received in revised form:
October 24,
2016
Received:
July 15,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
