Copyright ©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:
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.
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
Research background

The worldwide incidence of obesity is increasing and previous studies stated that it worsens the outcome of AP.

Research motivation

We wanted to provide detailed guidance on the clinical use of BMI in prognostic scoring.

Research objectives

To exactly identify which BMI subgroups are most in danger of a severe or even fatal disease outcome in AP.

Research methods

A systematic search was carried out in PubMed, Embase and Cochrane Library databases for studies investigating the effect of BMI on the outcome of AP. We used the PRISMA protocol, registered our project in PROSPERO and assessed the quality of the included articles by using a modified version of the Newcastle-Ottawa Scale. The statistical calculations were performed with Stata 11 SE, using the random effects model (DerSimonian-Laird method).

Research results

9997 patients with acute pancreatitis were included (19 articles) in this analysis. We found that AP patients with a BMI > 25 have a significantly increased risk of SAP with an OR of 2.87. A BMI > 30 means a significantly increased risk of mortality (OR = 2.89) while one with a BMI < 18.5 is also at a significantly higher risk of mortality compared to normal weight patients with an OR of 1.82.

Research conclusions

The new findings of this study identified that a BMI above 25 increases the risk of severe AP, but not mortality, while a BMI > 30 raises the risk of mortality. A BMI < 18.5 carries an almost two times higher risk of mortality in AP. It is the first meta-analysis that performs a detailed analysis on all WHO BMI categories with regard to both primary endpoints of AP. This helps to determine which BMI groups are at the highest risk of severe or even fatal outcome in AP.

Research perspectives

Our results give the opportunity for researchers to prepare the guidelines and scoring systems more precisely.