The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption,
hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP).
The aim of this meta-analysis was to evaluate the effects of these aetiological factors
on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012
and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP
AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures,
intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length
of hospital stay, pseudocyst, fluid collection and systematic inflammatory response
syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately
severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by
alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower
among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55-4.65 and 2.22-4.01,
respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR
= 1.72 and 1.50, 95% CI 1.04-2.84 and 0.96-2.35, respectively), pancreatic necrosis
occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08-2.30). Overall,
there is a potential association between aetiology and the development and course
of AP. HTG-AP is associated with the highest number of complications. Furthermore,
AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed
on determining aetiology on admission.
