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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2019; 25(6): 729-743
Published online Feb 14, 2019. doi: 10.3748/wjg.v25.i6.729
Body-mass index correlates with severity and mortality in acute pancreatitis: A meta-analysis
Dalma Dobszai, Péter Mátrai, Zoltán Gyöngyi, Dezső Csupor, Judit Bajor, Bálint Erőss, Alexandra Mikó, Lajos Szakó, Ágnes Meczker, Roland Hágendorn, Katalin Márta, Andrea Szentesi, Péter Hegyi, on behalf of the Hungarian Pancreatic Study Group
Dalma Dobszai, Péter Mátrai, Bálint Erőss, Alexandra Mikó, Lajos Szakó, Ágnes Meczker, Katalin Márta, Andrea Szentesi, Péter Hegyi, Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Dalma Dobszai, Andrea Szentesi, Clinical Medicine Doctoral School, University of Szeged, Szeged 6720, Hungary
Péter Mátrai, Institute for Bioanalysis, Medical School, University of Pécs, Pécs 7624, Hungary
Zoltán Gyöngyi, Department of Public Health Medicine, Medical School, University of Pécs, Pécs 7624, Hungary
Dezső Csupor, Department of Pharmacognosy, University of Szeged, Szeged 6720, Hungary
Judit Bajor, Roland Hágendorn, Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs 7624, Hungary
Katalin Márta, János Szentágothai Research Center, University of Pécs, Pécs 7624 Hungary
Péter Hegyi, MTA-SZTE Momentum Translational Gastroenterology Research Group, University of Szeged, Szeged 6720, Hungary
Author contributions: Dobszai D, Bajor J, Hágendorn R and Szakó L conducted the search in the databases. Mikó A, Meczker Á, Márta K and Csupor D read the articles for eligibility; in the case of conflict, the decision was left to a third participant, Hegyi P. Dobszai D, Meczker Á and Mikó A entered the data from the articles in an Excel file, while Mátrai P analyzed the data. Dobszai D and Gyöngyi Z carried out the bias analysis. Dobszai D, Mikó A and Márta K drafted the manuscript, and Szentesi A, Hágendorn R and Bajor J edited it. Meczker Á and Szentesi A edited the tables and figures. Dobszai D, Bajor J and Szakó L completed the items on the PRISMA-recommended checklist. Hegyi P and Erőss B made a critical revision of the finalized manuscript. All the authors read and approved the final manuscript.
Supported by a Project Grant (No. KH125678 to PH); an Economic Development and Innovation Operative Program Grant (GINOP 2.3.2-15-2016-00048 to PH; and a Human Resources Development Operational Program Grant (No. EFOP-3.6.2-16-2017-00006 to PH) from the National Research, Development and Innovation Office as well as by a Momentum Grant from the Hungarian Academy of Sciences (No. LP2014-10/2014 to PH); EFOP-3.6.3-VEKOP-16-2017-00009 and UNKP-18-3-INew National Excellence Program of the Ministry of Human Capacities (No. PTE/38329-1/2018 to KM).
Conflict-of-interest statement: The authors declare that no conflict of interest exists. There are no financial or other competing interests for principal investigators, patients included or any member of the trial.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Péter Hegyi, MD, PhD, DSc, Professor of Medicine, Director, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, Pécs H-7624, Hungary.
hegyi2009@gmail.com
Telephone: +36-70-3751031
Received: November 7, 2018
Peer-review started: November 12, 2018
First decision: November 22, 2018
Revised: December 4, 2018
Accepted: December 19, 2018
Article in press: December 20, 2018
Published online: February 14, 2019
Processing time: 99 Days and 2.6 Hours
BACKGROUND
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.
AIM
To quantify the association between subgroups of BMI and the severity and mortality of AP.
METHODS
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.
RESULTS
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, P < 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, P < 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, P < 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, P = 0.026).
CONCLUSION
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.
Core tip: It is the first detailed analysis on all World Health Organization body-mass index (BMI) categories, by comparing the normal BMI subgroup to all other subgroups of BMI with regard to both severity and mortality in acute pancreatitis (AP). Here we show that a BMI above 25 increases the risk of severe AP, while a BMI > 30 raises the risk of mortality. A BMI lower than eighteen point five carries an almost two times higher risk of mortality in AP.
