TY - JOUR
T1 - The association between obesity and outcomes in acute pancreatitis
T2 - An individual patient data meta-analysis
AU - the Dutch Pancreatitis Study Group
AU - Smeets, Xavier J.N.M.
AU - Knoester, Iris
AU - Grooteman, Karina V.
AU - Singh, Vikesh K.
AU - Banks, Peter A.
AU - Papachristou, Georgios I.
AU - Duarte-Rojo, Andres
AU - Robles-Diaz, Guillermo
AU - Kievit, Wietske
AU - Besselink, Marc G.H.
AU - Verdonk, Robert C.
AU - Van Santvoort, Hjalmar C.
AU - Drenth, Joost P.H.
AU - Belias, Michael
AU - Van Geenen, Erwin J.M.
N1 - Funding Information:
This study was funded by The Netherlands Organisation for Health Research and Development (ZonMw), project number 837001506.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - 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.
AB - 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.
KW - acute pancreatitis
KW - mortality
KW - obesity
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85061067834&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061067834&partnerID=8YFLogxK
U2 - 10.1097/MEG.0000000000001300
DO - 10.1097/MEG.0000000000001300
M3 - Article
C2 - 30399003
AN - SCOPUS:85061067834
SN - 0954-691X
VL - 31
SP - 316
EP - 322
JO - European Journal of Gastroenterology and Hepatology
JF - European Journal of Gastroenterology and Hepatology
IS - 3
ER -