The Impact of Liver Cirrhosis on Clinical Outcomes in Patients With Acute Pancreatitis: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis analyzed the impact of liver cirrhosis (LC) on clinical outcomes in patients hospitalized with acute pancreatitis (AP). We searched multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library from inception to April 26, 2025, and included studies comparing outcomes between AP patients with and without LC. From the 1,233 initially identified studies, eight retrospective studies with a pooled sample of 3,513,655 patients were included in the final analysis, with an LC prevalence of 2.90%. Meta-analysis revealed that AP patients with LC had significantly higher mortality risk compared to non-cirrhotic patients [risk ratio (RR): 2.09, 95% confidence interval (CI): 1.74-2.52], with considerable heterogeneity (I² = 66%). Subgroup analysis of studies reporting adjusted effect estimates confirmed this finding (RR: 1.94, 95% CI: 1.52-2.48) with lower heterogeneity (I² = 28%). Cirrhotic patients also experienced significantly more severe AP (RR: 2.79, 95% CI: 1.53-5.11) with no heterogeneity among studies (I² = 0%). However, analysis showed no significant difference in acute kidney injury (AKI) risk between cirrhotic and non-cirrhotic patients (RR: 1.09, 95% CI: 0.84-1.41). Our findings highlight the importance of early identification and vigilant monitoring of cirrhotic patients with AP, who may benefit from coordinated multidisciplinary care involving hepatologists, nephrologists, and infectious disease specialists. The limitations of the study include the retrospective design of all included studies, insufficient granularity for comprehensive subgroup analyses based on liver disease etiology or fibrosis stage, and inconsistent reporting of key clinical outcomes across studies. Future prospective research should address these limitations to better inform personalized management strategies.