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The association between obesity and outcomes in acute pancreatitis

an individual patient data meta-analysis

Smeets, Xavier J.N.M.a; Knoester, Irisa; Grooteman, Karina V.a; Singh, Vikesh K.g; Banks, Peter A.h; Papachristou, Georgios I.i; Duarte-Rojo, Andresj; Robles-Diaz, Guillermok; Kievit, Wietskeb; Besselink, Marc G.H.c; Verdonk, Robert C.d; Van Santvoort, Hjalmar C.e,f; Drenth, Joost P.H.a; Belias, Michaelb; Van Geenen, Erwin J.M.a for the Dutch Pancreatitis Study Group

European Journal of Gastroenterology & Hepatology: March 2019 - Volume 31 - Issue 3 - p 316–322
doi: 10.1097/MEG.0000000000001300
Original Articles: Gastroenterology
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Objectives 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.

Patients and methods 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.

Results 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).

Conclusion 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.

Departments of aGastroenterology and Hepatology

bHealth Evidence, Radboud University Medical Center, Nijmegen

cDepartment of Surgery, Academic Medical Center, Amsterdam

Departments of dGastroenterology and Hepatology

eSurgery, St. Antonius Hospital, Nieuwegein

fDepartment of Surgery, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands

gDivision of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland

hDivision of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts

iDivision of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

jDivision of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

kDepartment of Pancreas Clinic-Gastroenterology, Research Division, School of Medicine, UNAM, The National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico

Correspondence to Xavier J.N.M. Smeets, MD, Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Tel: +31 883 207 054; fax: +31 243 635 129; e-mail: xavier.smeets@radboudumc.nl

Received July 15, 2018

Accepted August 30, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.