The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta-analysis and meta-regression analysis

Abstract

Background and Aim: The study aims to determine and quantify the stratified risk of recurrent pancreatitis (RP) after the first episode of acute pancreatitis in relation to etiology and severity of disease. Methods: A systematic review and meta-analysis in compliance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies investigating the risk of RP after the first episode of acute pancreatitis. Proportion meta-analysis models using random effects were constructed to calculate the weighted summary risks of RP. Meta-regression was performed to evaluate the effect of different variables on the pooled outcomes. Results: Analysis of 57,815 patients from 42 studies showed that the risk of RP after first episode was 19.8% (95% confidence interval [CI] 17.5–22.1%). The risk of RP was 11.9% (10.2–13.5%) after gallstone pancreatitis, 28.7% (23.5–33.9%) after alcohol-induced pancreatitis, 30.3% (15.5–45.0%) after hyperlipidemia-induced pancreatitis, 38.1% (28.9–47.3%) after autoimmune pancreatitis, 15.1% (11.6–18.6%) after idiopathic pancreatitis, 22.0% (16.9–27.1%) after mild pancreatitis, 23.9% (12.9–34.8%) after moderate pancreatitis, 21.6% (14.6–28.7%) after severe pancreatitis, and 6.6% (4.1–9.2%) after cholecystectomy following gallstone pancreatitis. Meta-regression confirmed that the results were not affected by the year of study (P = 0.541), sample size (P = 0.064), length of follow-up (P = 0.348), and age of patients (P = 0.138) in the included studies. Conclusions: The risk of RP after the first episode of acute pancreatitis seems to be affected by the etiology of pancreatitis but not the severity of disease. The risks seem to be higher in patients with autoimmune pancreatitis, hyperlipidemia-induced pancreatitis, and alcohol-induced pancreatitis and lower in patients with gallstone pancreatitis and idiopathic pancreatitis.