HbA1c and the Severity of Acute Pancreatitis: A Systematic Review and Meta-Analysis.

BACKGROUND: HbA1c, a measure of long-term glycaemic control, has been identified as a potential prognostic risk factor for pancreatitis severity, yet there is a paucity of evidence on its association with pancreatitis outcomes in people with and without diabetes. We, therefore, conducted a systematic review and meta-analysis to assess the current body of evidence. METHODS: Articles from January 1980 to March 2025 were screened using PubMed and the Excerpta Medica database (Embase). Randomised control trials (RCTs), cohort, and case-control studies were permitted for inclusion if they used an appropriate method for both acute pancreatitis (AP) diagnosis and severity classification. Quality assessment was performed using the Newcastle-Ottawa scale (NOS), and random effects models reporting pooled odds ratios (ORs) were estimated in our meta-analyses. RESULTS: Our search generated 2,270 results, from which two studies were eligible for inclusion with a total of 1,195 participants. Both studies were deemed to be at low risk of bias. The results of our meta-analyses demonstrated an increased odds of developing severe AP with increased HbA1c levels (OR = 2.14, 95% confidence interval (CI) 1.32-3.48). Elevated HbA1c levels were also found to increase the odds for developing local pancreatic complications (OR = 1.71, 95% CI 1.25-2.34) and systemic complications (pooled OR = 2.82, 95% CI 0.49-16.28). CONCLUSIONS: Our review suggests that elevated HbA1c levels may increase the likelihood of developing severe AP as well as local and systemic complications. The results of the review are limited due to the small number of included studies. We recommend that large multicentre cohort studies be conducted to further investigate this relationship.