Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary.
Department of Public Health Medicine, Medical School, University of Pécs, Pécs 7624, Hungary.
World J Gastroenterol. 2019 Feb 14;25(6):729-743. doi: 10.3748/wjg.v25.i6.729.
Obesity rates have increased sharply in recent decades. As there is a growing number of cases in which acute pancreatitis (AP) is accompanied by obesity, we found it clinically relevant to investigate how body-mass index (BMI) affects the outcome of the disease.
To quantify the association between subgroups of BMI and the severity and mortality of AP.
A meta-analysis was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols. Three databases (PubMed, EMBASE and the Cochrane Library) were searched for articles containing data on BMI, disease severity and mortality rate for AP. English-language studies from inception to 19 June 2017 were checked against our predetermined eligibility criteria. The included articles reported all AP cases with no restriction on the etiology of the disease. Only studies that classified AP cases according to the Atlanta Criteria were involved in the severity analyses. Odds ratios (OR) and mean differences (MD) were pooled using the random effects model with the DerSimonian-Laird estimation and displayed on forest plots. The meta-analysis was registered in PROSPERO under number CRD42017077890.
A total of 19 articles were included in our meta-analysis containing data on 9997 patients. As regards severity, a subgroup analysis showed a direct association between AP severity and BMI. BMI < 18.5 had no significant effect on severity; however, BMI > 25 had an almost three-fold increased risk for severe AP in comparison to normal BMI (OR = 2.87, 95%CI: 1.90-4.35, < 0 .001). Importantly, the mean BMI of patients with severe AP is higher than that of the non-severe group (MD = 1.79, 95%CI: 0.89-2.70, < 0.001). As regards mortality, death rates among AP patients are the highest in the underweight and obese subgroups. A BMI < 18.5 carries an almost two-fold increase in risk of mortality compared to normal BMI (OR = 1.82, 95%CI: 1.32-2.50, < 0.001). However, the chance of mortality is almost equal in the normal BMI and BMI 25-30 subgroups. A BMI > 30 results in a three times higher risk of mortality in comparison to a BMI < 30 (OR = 2.89, 95%CI: 1.10-7.36, = 0.026).
Our findings confirm that a BMI above 25 increases the risk of severe AP, while a BMI > 30 raises the risk of mortality. A BMI < 18.5 carries an almost two times higher risk of mortality in AP.
肥胖率在最近几十年急剧上升。由于越来越多的急性胰腺炎（AP）病例伴有肥胖，我们发现研究体重指数（BMI）如何影响疾病的结果具有临床意义。
定量分析 BMI 亚组与 AP 的严重程度和死亡率之间的关系。
采用系统评价和荟萃分析的首选报告项目（PRISMA）方案进行荟萃分析。检索了三个数据库（PubMed、EMBASE 和 Cochrane Library），以查找包含 BMI、疾病严重程度和 AP 死亡率数据的文章。针对我们预定的纳入标准，对从成立到 2017 年 6 月 19 日的英文研究进行了检查。纳入的文章报告了所有 AP 病例，且不受疾病病因的限制。仅纳入根据亚特兰大标准对 AP 病例进行分类的研究进行严重程度分析。使用随机效应模型和 DerSimonian-Laird 估计值汇总比值比（OR）和均数差值（MD），并显示在森林图上。该荟萃分析已在 PROSPERO 中注册，注册号为 CRD42017077890。
共有 19 篇文章纳入了本荟萃分析，包含了 9997 名患者的数据。关于严重程度，亚组分析显示 AP 严重程度与 BMI 之间存在直接关联。BMI <18.5 对严重程度无显著影响；然而，与正常 BMI 相比，BMI >25 使患严重 AP 的风险几乎增加了三倍（OR = 2.87，95%CI：1.90-4.35，<0.001）。重要的是，严重 AP 患者的平均 BMI 高于非严重组（MD = 1.79，95%CI：0.89-2.70，<0.001）。关于死亡率，AP 患者的死亡率在体重不足和肥胖亚组中最高。BMI <18.5 与正常 BMI 相比，死亡风险几乎增加了两倍（OR = 1.82，95%CI：1.32-2.50，<0.001）。然而，正常 BMI 和 BMI 25-30 亚组的死亡风险几乎相同。BMI >30 与 BMI <30 相比，死亡风险增加了三倍（OR = 2.89，95%CI：1.10-7.36，=0.026）。
我们的研究结果证实，BMI 超过 25 会增加患严重 AP 的风险，而 BMI 超过 30 会增加死亡风险。BMI <18.5 会使 AP 的死亡风险增加近两倍。
