Influencing factors for acute necrotizing pancreatitis in Eastern and Western countries: A meta-analysis / 临床肝胆病杂志

ABSTRACT

Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[ OR ]=1.51, 95% confidence interval[ CI ] 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[ SMD ]=1.39, 95% CI 1.06-1.71, P < 0.01), D-dimer ( SMD =0.44, 95% CI 0.07-0.81, P =0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[ MD ]=3.51, 95% CI 1.38-5.64, P < 0.01), alcoholic etiology ( OR =3.57, 95% CI 2.68-4.75, P < 0.01), and biliary etiology ( OR =0.60, 95% CI 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex ( OR =1.63, 95% CI 1.30-2.05, P < 0.01), CRP ( SMD =2.09, 95% CI 1.12-3.05, P < 0.01), APACHE-Ⅱ score ( MD =4.28, 95% CI 2.73-5.83, P < 0.01), Ranson score ( MD =2.99, 95% CI 2.50-3.47, P < 0.01), and organ failure ( OR =10.87, 95% CI 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age ( MD =2.16, 95% CI 0.43-3.89, P =0.01), body mass index (BMI)( MD =1.74, 95% CI 1.23-2.25, P < 0.01), albumin level ( SMD =-0.43, 95% CI -0.75 to-0.12, P < 0.01), CRP ( SMD =0.58, 95% CI 0.04-1.11, P =0.03), procalcitonin ( SMD =0.80, 95% CI 0.56-1.04, P < 0.01), D-dimer ( MD =0.23, 95% CI 0.15-0.31, P < 0.01), APACHE-Ⅱ score ( MD =2.47, 95% CI 0.73-4.22, P < 0.01), Ranson score ( MD =1.60, 95% CI 1.46-1.73, P < 0.01), and extent of necrosis ≥30%( OR =2.52, 95% CI 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age ( MD =4.07, 95% CI 1.82-6.31, P < 0.01), APACHE-Ⅱ score ( MD =3.28, 95% CI 1.39-5.17, P < 0.01), Ranson score ( MD =2.18, 95% CI 1.75-2.62, P < 0.01), SIRS score ( OR =3.88, 95% CI 1.58-9.51, P < 0.01), alcoholic etiology ( OR =0.61, 95% CI 0.42-0.87, P < 0.01), and organ failure ( OR =3.63, 95% CI 1.11-11.92, P =0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.