Metabolic-associated fatty liver disease is associated with acute pancreatitis with more severe course: Post hoc analysis of a prospectively collected international registry

Szilárd Váncsa; Zoltán Sipos; Alex Váradi; Rita Nagy; Klementina Ocskay; Félix Márk Juhász; Katalin Márta; Brigitta Teutsch; Alexandra Mikó; Péter Jenő Hegyi; Áron Vincze; Ferenc Izbéki; László Czakó; Mária Papp; József Hamvas; Márta Varga; Imola Török; Artautas Mickevicius; Bálint Erőss; Andrea Párniczky; Andrea Szentesi; Gabriella Pár; Péter Hegyi; Hungarian Pancreatic Study Group

doi:10.1002/ueg2.12389

Metabolic-associated fatty liver disease is associated with acute pancreatitis with more severe course: Post hoc analysis of a prospectively collected international registry

United European Gastroenterol J. 2023 May;11(4):371-382. doi: 10.1002/ueg2.12389. Epub 2023 Apr 16.

Authors

Szilárd Váncsa^{1

2

3}, Zoltán Sipos^{1

4}, Alex Váradi^{1

5

6}, Rita Nagy^{1

2

7}, Klementina Ocskay^{1

7}, Félix Márk Juhász^{1

7}, Katalin Márta^{2

3}, Brigitta Teutsch^{1

2}, Alexandra Mikó^{1

8}, Péter Jenő Hegyi^{1

2

3}, Áron Vincze⁹, Ferenc Izbéki¹⁰, László Czakó¹¹, Mária Papp¹², József Hamvas¹³, Márta Varga¹⁴, Imola Török¹⁵, Artautas Mickevicius^{16

17}, Bálint Erőss^{1

2

3}, Andrea Párniczky^{1

2

7}, Andrea Szentesi^{1

18}, Gabriella Pár^{1

9}, Péter Hegyi^{1

2

3

18}; Hungarian Pancreatic Study Group

Collaborators

Hungarian Pancreatic Study Group:
Marcell Imrei, Mária Földi, Emőke Miklós, Szilárd Gódi, Roland Hágendorn, Patricia Sarlós, Judit Bajor, Imre Szabó, József Czimmer, Nándor Faluhelyi, Orsolya Farkas, Péter Kanizsai, Tamás Nagy, Balázs Németh, Balázs Kui, Dóra Illés, Tamás Takács, László Gajdán, Zsuzsanna Vitális, Barnabás Bod, János Novák, Melania Macarie, Pál Maurovich-Horváth, Attila Doros, Pál Ákos Deák, Csaba Varga, Szabolcs Gaál, László Zubek, János Gál, Árpád Patai, Tamás Tornai, Balázs Lázár, Tamás Hussein, Beáta Kovács, Dorottya Tarján, Mónika Lipp, Orsolya Urbán, Fürst Emese, Tari Edina

Affiliations

¹ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
² Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
³ Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
⁴ Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary.
⁵ Department of Metagenomics, University of Debrecen, Debrecen, Hungary.
⁶ Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁷ Heim Pál National Pediatric Institute, Budapest, Hungary.
⁸ Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary.
⁹ Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
¹⁰ Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary.
¹¹ Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary.
¹² Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
¹³ Peterfy Hospital, Budapest, Hungary.
¹⁴ Department of Gastroenterology, BMKK Dr. Réthy Pál Hospital, Békéscsaba, Hungary.
¹⁵ County Emergency Clinical Hospital of Targu Mures - Gastroenterology and George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania.
¹⁶ Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
¹⁷ Clinics of Abdominal Surgery, Nephrology and Gastroenterology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹⁸ Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation University of Szeged, Szeged, Hungary.

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a proven risk factor for acute pancreatitis (AP). However, NAFLD has recently been redefined as metabolic-associated fatty liver disease (MAFLD). In this post hoc analysis, we quantified the effect of MAFLD on the outcomes of AP.

Methods: We identified our patients from the multicentric, prospective International Acute Pancreatitis Registry of the Hungarian Pancreatic Study Group. Next, we compared AP patients with and without MAFLD and the individual components of MAFLD regarding in-hospital mortality and AP severity based on the revised Atlanta classification. Lastly, we calculated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression analysis.

Results: MAFLD had a high prevalence in AP, 39% (801/2053). MAFLD increased the odds of moderate-to-severe AP (OR = 1.43, CI: 1.09-1.89). However, the odds of in-hospital mortality (OR = 0.89, CI: 0.42-1.89) and severe AP (OR = 1.70, CI: 0.97-3.01) were not higher in the MAFLD group. Out of the three diagnostic criteria of MAFLD, the highest odds of severe AP was in the group based on metabolic risk abnormalities (OR = 2.68, CI: 1.39-5.09). In addition, the presence of one, two, and three diagnostic criteria dose-dependently increased the odds of moderate-to-severe AP (OR = 1.23, CI: 0.88-1.70, OR = 1.38, CI: 0.93-2.04, and OR = 3.04, CI: 1.63-5.70, respectively) and severe AP (OR = 1.13, CI: 0.54-2.27, OR = 2.08, CI: 0.97-4.35, and OR = 4.76, CI: 1.50-15.4, respectively). Furthermore, in patients with alcohol abuse and aged ≥60 years, the effect of MAFLD became insignificant.

Conclusions: MAFLD is associated with AP severity, which varies based on the components of its diagnostic criteria. Furthermore, MAFLD shows a dose-dependent effect on the outcomes of AP.

Keywords: MAFLD; NAFLD; acute pancreatitis; metabolic syndrome; metabolic-associated fatty liver disease; mortality; non-alcoholic fatty liver disease; prognosis; severity; steatosis.

MeSH terms

Acute Disease
Humans
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / diagnosis
Non-alcoholic Fatty Liver Disease* / epidemiology
Pancreatitis* / diagnosis
Pancreatitis* / epidemiology
Pancreatitis* / etiology
Prospective Studies
Registries