Smeets Xavier J N M, Knoester Iris, Grooteman Karina V, Singh Vikesh K, Banks Peter A, Papachristou Georgios I, Duarte-Rojo Andres, Robles-Diaz Guillermo, Kievit Wietske, Besselink Marc G H, Verdonk Robert C, Van Santvoort Hjalmar C, Drenth Joost P H, Belias Michael, Van Geenen Erwin J M
Departments of Gastroenterology and Hepatology.
Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Eur J Gastroenterol Hepatol. 2019 Mar;31(3):316-322. doi: 10.1097/MEG.0000000000001300.
There are data to suggest that obesity is associated with local and systemic complications as well as mortality in acute pancreatitis (AP). Cohort studies to date, however, have shown conflicting results from mostly unadjusted analyses. Therefore, we performed an individual patient data meta-analysis with the primary aim to investigate the association between obesity and mortality in AP. Our secondary aim was to investigate the association between obesity and necrosis, organ failure, multiple organ failure, and invasive intervention.
We systematically searched four electronic databases for prospective studies on obesity and outcomes in AP. Researchers of eligible studies were invited to share individual patient data using a standardized data collection form. All end points were investigated with a one-stage mixed effects Poisson model with random intercepts and forced entry of relevant confounders.
We included five databases with 1302 patients, of whom 418 (32%) were obese. In total, 466 (36%) patients had necrosis, 328 (25%) had organ failure, 188 (14%) had multiple organ failure, 210 (16%) had an intervention, and 84 (7%) patients died. We found no significant association between obesity and mortality [relative risk (RR) 1.40, 95% confidence interval (CI): 0.89-2.20], necrosis (RR: 1.08, 95% CI: 0.90-1.31) or invasive intervention (RR: 1.10, 95% CI: 0.83-1.47) after adjustment for confounders. However, obesity was independently associated with the development of organ failure (RR: 1.38, 95% CI: 1.11-1.73) and multiple organ failure (RR: 1.81, 95% CI: 1.35-2.42).
Obesity is independently associated with the development of organ failure and multiple organ failure in AP. However, there is no association between obesity and mortality, necrosis, and an intervention.
有数据表明肥胖与急性胰腺炎（AP）的局部和全身并发症以及死亡率相关。然而，迄今为止的队列研究大多未经调整分析，结果相互矛盾。因此，我们进行了一项个体患者数据荟萃分析，主要目的是研究肥胖与AP死亡率之间的关联。我们的次要目的是研究肥胖与坏死、器官衰竭、多器官衰竭和侵入性干预之间的关联。
我们系统检索了四个电子数据库，以查找关于肥胖与AP结局的前瞻性研究。邀请符合条件的研究的研究者使用标准化数据收集表分享个体患者数据。所有终点均采用具有随机截距和强制纳入相关混杂因素的单阶段混合效应泊松模型进行研究。
我们纳入了五个数据库中的1302例患者，其中418例（32%）为肥胖患者。总共有466例（36%）患者发生坏死，328例（25%）发生器官衰竭，188例（14%）发生多器官衰竭，210例（16%）接受了干预，84例（7%）患者死亡。在对混杂因素进行调整后，我们发现肥胖与死亡率[相对风险（RR）1.40，95%置信区间（CI）：0.89 - 2.20]、坏死（RR：l.08，95% CI：0.90 - 1.31）或侵入性干预（RR：1.10，95% CI：0.83 - 1.47）之间无显著关联。然而，肥胖与器官衰竭（RR：1.38，95% CI：1.11 - 1.73）和多器官衰竭（RR：1.81，95% CI：1.35 - 2.42）的发生独立相关。
肥胖与AP中器官衰竭和多器官衰竭的发生独立相关。然而，肥胖与死亡率、坏死和干预之间无关联。
