Frequency of Fatty Liver in Patients Presenting with Acute Pancreatitis and Its Association with Disease Severity

Background: Non-alcoholic fatty liver disease (NAFLD) may worsen the course of acute pancreatitis, yet evidence from regional settings is limited. Objective: To estimate the frequency of NAFLD among patients with acute pancreatitis and evaluate its association with radiological severity. Methods: A cross-sectional study was conducted in the department of Radiology, CMH Multan (June–December 2024). Consecutive adults (18–65 years) presenting within 24 hours and fulfilling clinical and biochemical criteria for acute pancreatitis underwent non-contrast abdominal computed tomography. NAFLD was defined by a liver-to-spleen attenuation ratio <1 with ≥10 Hounsfield Unit difference in individuals without alcohol use. Severity was graded using the CT Severity Index (CTSI). Results: Ninety-five patients were analyzed (61.1% male; mean age 42.3±13.7 years); NAFLD was present in 41/95 (43.2%). Compared with non-NAFLD, NAFLD cases had higher body mass index (29.2±4.1 vs 24.7±3.8 kg/m²; p<0.001) and more diabetes (41.5% vs 18.5%; p=0.014) and hypertension (46.3% vs 22.2%; p=0.016). Median amylase and lipase were higher in NAFLD (both p<0.001). Severity shifted toward higher CTSI categories with NAFLD (mild 26.8% vs 68.5%, moderate 48.8% vs 27.8%, severe 24.4% vs 3.7%; p<0.001); mean CTSI was 4.2±2.8 vs 2.1±1.9 (p<0.001). NAFLD was associated with moderate-to-severe pancreatitis (OR 4.83; 95% CI 2.14–10.91) and severe pancreatitis (OR 8.37; 95% CI 1.79–39.14). Radiological complications were more frequent with NAFLD: necrosis 31.7% vs 11.1% (p=0.015), peripancreatic fluid 58.5% vs 33.3% (p=0.018), pseudocyst 19.5% vs 5.6% (p=0.037). Findings were consistent across strata. Conclusions: NAFLD was common and associated with higher CTSI severity and local complications; routine CT assessment of hepatic steatosis may aid early risk stratification.