S2544 Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Predicts Severe Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Introduction: Acute pancreatitis (AP) carries significant morbidity, with moderate-to-severe cases exhibiting mortality rates up to 50%. Identifying predictive factors remains critical, yet MASLD, despite preliminary evidence linking it to worse AP outcomes, is not incorporated in current risk stratification tools. This meta-analysis evaluates whether MASLD at admission predicts severe AP and worsened clinical outcomes. Methods: We performed a systematic review following PRISMA guidelines. PubMed, Scopus, and Web of Science were searched through April 2025 for studies reporting outcomes of AP in patients with MASLD. Eligible studies included observational cohorts reporting odds ratios (OR), hazard ratios (HR), or risk differences with 95% confidence intervals (CIs). Exclusion criteria included pediatric studies, case reports, reviews, guidelines, post-hoc analyses, and editorials. Data were synthesized using random-effects and fixed-effects models, as appropriate. Results: Out of the total 2959 researches (Pubmed: 527, EMBASE: 1955, WOS: 477), Five observational cohort studies comprising 5,068 AP patients (1,217 with MASLD) were included. MASLD significantly increased the odds of severe AP (pooled OR 2.74, 95% CI 2.31–3.25; P < 0.001) with negligible heterogeneity (I² = 0%). Patients with MASLD experienced significantly prolonged hospital stays (standardized mean difference 0.58, 95% CI 0.45–0.72), corresponding to approximately 2–3 additional inpatient days, though heterogeneity was substantial (I² = 99%). Additionally, MASLD was associated with an absolute 4% increase in mortality (risk difference 0.04, 95% CI 0.02–0.06; P < 0.001), with moderate heterogeneity (I² = 61%). Conclusion: MASLD independently predicts severe disease, increased hospital stay, and higher mortality in patients with acute pancreatitis. Incorporating MASLD into existing predictive tools could enhance risk stratification and clinical management.