Highlights
- •liver cirrhosis (LC) predisposes to adverse outcomes of acute pancreatitis (AP), with high rates of acute-on-chronic liver failure (ACLF) and significant mortality.
- •cirrhosis patients require significantly more radiological and endoscopic interventions over the course of AP, with higher complication rates compared to non-cirrhotic AP patients.
- •adverse outcomes of LC-AP are not adequately predicted by established AP scores, but by SOFA, ACLFs and particularly MELD scores.
- •clinical evidence of overt portal hypertension identifies LC patients at highest risk of AP-related complications, further decompensation and death.
Abstract
Background & aims
Acute pancreatitis (AP) is a frequent indication for hospitalization and may present
with varying degrees of severity. AP often coincides with hepatic disease, yet the
impact of liver cirrhosis (LC) on the course of AP is uncertain, and early identification
of patients at risk for complications remains challenging. We aimed to assess the
impact of LC on the development of pancreatic and extra-pancreatic complications of
AP, and to identify predictors of adverse outcomes in cirrhotic patients.
Methods
All adult patients with LC and AP (LC-AP, n = 52) admitted to our institution between 01/2011–03/2020 were subjected to a 1:2
matched-pair analysis with patients with AP but without LC (NLC-AP, n = 104).
Results
At hospital admission, Glasgow-Imrie and Ranson scores as well as markers of systemic
inflammation were comparable in LC-AP and NLC-AP patients, and both groups had similar
rates of necrotizing AP. Infectious complications were more prevalent, and medical
interventions were performed more often and with higher complication rates in LC-AP
patients. While only 12.5% of NLC-AP patients developed organ failures, 48% of LC-AP
patients developed single (7.7%) or multiple organ failure (40.4%), resulting in 44%
of LC-AP patients with acute-on-chronic liver failure (ACLF). Patients with overt
portal hypertension were particularly prone for decompensation. Mortality was higher
among LC-AP compared to NLC-AP patients (6-month mortality 25% vs. 1.9%, p < 0.001), and SOFA and MELD scores at admission most accurately predicted outcomes
in LC-AP.
Conclusion
Among AP patients, concomitant cirrhosis substantially increases the risk for infections,
periprocedural complications, multiorgan failure and death.
Keywords
Abbreviations:
ACLF (acute-on-chronic liver failure), AP (acute pancreatitis), CCI (Charlson comorbidity index), LC (liver cirrhosis), MELD (model for end-stage liver disease)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 04, 2022
Accepted:
May 27,
2022
Received in revised form:
May 18,
2022
Received:
January 21,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
