Chronic liver disease impacting the severity of acute pancreatitis: a detailed narrative review of the literature.

Abstract

Chronic Liver Disease (CLD) and Acute Pancreatitis (AP) are significant global health burdens, often coexisting in clinical settings. This narrative review explores the complex interplay between CLD and the severity of AP. CLD contributes to immune dysregulation, hemodynamic instability, and metabolic disturbances, which may amplify the inflammatory and systemic effects of AP. The review discusses overlapping pathophysiological mechanisms, including cytokine-driven inflammation, portal hypertension, and impaired hepatic detoxification. It also highlights diagnostic challenges due to overlapping clinical features and limitations in conventional markers. Evidence suggests that CLD worsens AP outcomes, increasing risks of pancreatic necrosis, organ failure, and mortality. The influence of liver disease etiology, such as alcoholic or viral origins, further modifies AP severity. The evidence base is dominated by retrospective cohorts, single-center series, and administrative database analyses, with almost no prospective data. Definitions of CLD vary considerably between studies, adjustment for confounders such as ongoing alcohol use, sarcopenia, and baseline infection is inconsistent, and the reported effect sizes differ more widely than the uniformity of the published conclusions would suggest. The review also examines why conventional severity scores may perform sub optimally in this population and where liver-specific scores may add value. Enhanced understanding of these interactions is essential for early diagnosis, risk stratification, and tailored management strategies. This review underscores the need for integrated clinical approaches in patients affected by both hepatic and pancreatic disorders, and identifies the specific evidence gaps whose resolution would most change practice.