Clinical features and prognosis of acute pancreatitis with nonalcoholic fatty liver disease

• Main Author: YAN Yongfeng
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2020-05-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=10782

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with the severity of acute pancreatitis (AP). MethodsA total of 398 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January to August 2019 were enrolled, among whom there were 197 patients with mild acute pancreatitis (MAP), 151 patients with moderate-severe acute pancreatitis (MSAP), and 50 patients with severe acute pancreatitis (SAP). According to the presence or absence of NAFLD, these patients were divided into NAFLD group with 206 patients and non-NAFLD group with 192 patients. The two groups were compared in terms of the clinical features and prognosis, including baseline data, serological markers, etiology, complications, commonly used AP scores, length of hospital stay, and mortality rate. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups; a logistic regression analysis was performed with the development of MSAP as the endpoint. ResultsThere were significant differences between the two groups in age, proportion of male patients, body mass index, total cholesterol, triglyceride, Na+, white blood cell count, neutrophil count, blood glucose, and serum creatinine (all P＜0.05), and compared with the non-NAFLD group, the NAFLD group tended to have a higher proportion of patients with abnormal glucose metabolism or abnormal lipid metabolism (P＜0.05). There was a significant difference in etiological composition between the two groups (P＜0.001), with the main etiology of hyperlipidemia in the NAFLD group (481%) and biliary disease in the non-NAFLD group (57.8%). Compared with the non-NAFLD group, the NAFLD group had significantly higher proportion of patients with MSAP, RANSON score, and Balthazar score (all P＜0.05), as well as significantly higher incidence rates of systemic inflammatory response syndrome (SIRS) (P＜0.001), acute peripancreatic fluid collection (χ2=15.820, P＜0001), and acute necrotic collection (χ2=7.012, P=0.008). Compared with the non-NAFLD group, the NAFLD had a significantly higher risk of recurrence (30.6% vs 19.3%, χ2=6.759, P=0.009) and higher incidence rate of multiple organ dysfunction (12.6% vs 8.9%, P＞0.05) and mortality rate (3.4% vs 1.2%, P＞0.05). NAFLD, abnormal glucose metabolism, and lymphocyte count were independent risk factors for MSAP (all P＜0.05). ConclusionAP patients with NAFLD tend to develop SIRS and local complications of the pancreas and have a high disease grade, a poor prognosis, and a high risk of recurrence.