Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Emergency Medicine, Northeast Georgia Medical Center, Gainesville, Georgia.
Eur J Gastroenterol Hepatol. 2023 Oct 1;35(10):1067-1074. doi: 10.1097/MEG.0000000000002607. Epub 2023 Jul 11.
Evidence suggests that patients with inflammatory bowel disease are at higher risk of developing nonalcoholic fatty liver disease (NAFLD). However, there is limited information currently available on how NAFLD may affect the clinical course of IBD. Thus, we conducted a systematic review to evaluate the impact of NAFLD on IBD-related hospitalization outcomes. All observational studies assessing IBD-related hospitalization outcomes in patients with NAFLD were included. Exclusion criteria were studies published in languages other than English or French, or those involving pediatric population. Outcomes included IBD-related hospitalization and readmission rates, need for surgery, length of stay, inpatient mortality, and costs. Overall, 3252 citations were retrieved and seven studies met the inclusion criteria (1 574 937 patients); all were observational, of high quality, and originated in the United States. Measurable outcomes reported in these studies were few and with insufficient similarity across studies to complete a quantitative assessment. Only one study reports NAFLD severity. Two studies suggested a higher rate of hospitalization for patients with both NAFLD and IBD compared to IBD alone (incidence rate ratio of 1.54; 95% confidence interval: 1.33-1.79). This is the first systematic review to date that evaluates any possible association of NAFLD with IBD-related hospitalization outcomes. Despite the paucity and low quality of available data, our findings indicate that NAFLD may be associated with worse outcomes amongst IBD patients (especially Crohn's disease). Further and higher certainty of evidence is needed for better characterization of such clinical impact.
有证据表明，炎症性肠病患者发生非酒精性脂肪性肝病（NAFLD）的风险更高。然而，目前关于 NAFLD 如何影响 IBD 的临床病程的信息有限。因此，我们进行了一项系统评价，以评估 NAFLD 对 IBD 相关住院结局的影响。所有评估 NAFLD 患者的 IBD 相关住院结局的观察性研究均被纳入。排除标准为发表语言非英语或法语的研究，或涉及儿科人群的研究。结局包括 IBD 相关住院和再入院率、手术需求、住院时间、住院死亡率和费用。总共检索到 3252 条引用，有 7 项研究符合纳入标准（1574937 例患者）；均为观察性研究，质量较高，且来自美国。这些研究中报告的可衡量结局较少，且各研究间的相似性不足，无法进行定量评估。仅有一项研究报告了 NAFLD 的严重程度。两项研究表明，与单独患有 IBD 的患者相比，同时患有 NAFLD 和 IBD 的患者住院率更高（发病率比为 1.54；95%置信区间：1.33-1.79）。这是迄今为止评估 NAFLD 与 IBD 相关住院结局之间任何可能关联的第一项系统评价。尽管可用数据的数量少且质量低，但我们的研究结果表明，NAFLD 可能与 IBD 患者的结局更差相关（尤其是克罗恩病）。需要进一步和更高确定性的证据来更好地描述这种临床影响。
