Acute Pancreatitis in Patients With Severe Hypertriglyceridemia in a Multi-Ethnic Minority Population

Amblee, Ambika; Mohananey, Divyanshu; Morkos, Micheal; Basu, Sanjib; Abegunde, Ayokunle T.; Ganesh, Malini; Bhalerao, Neil; George, Amrutha Mary; Jain, Milli; Fogelfeld, Leon

doi:10.4158/ep-2017-0178

Cited by 26 publications

(31 citation statements)

References 18 publications

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“…The body mass index (BMI) is a measure of obesity and a higher BMI was independently associated with increased risks of acute kidney injury [30]. Hyperlipidemia, especially high circulating concentrations of triglycerides, can lead to the development of severe and systemic complications in patients with acute pancreatitis [31,32]. Hyperuricemia is linked to metabolic syndrome [33] and has been shown to predict kidney disease onset and progression [34,35].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a predictive model for predicting acute kidney injury in patients with acute pancreatitis

Yang¹,

Kang²,

Wen³

et al. 2020

Preprint

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Background: Acute kidney injury is a serious complication of acute pancreatitis and significantly increases the risk of mortality. Early identification of acute kidney injury is important for medical interventions and care options. The aim of this study is to develop a predictive model that could rapidly identify high-risk population of acute kidney injury in patients with acute pancreatitis. Methods: Totally 808 patients with acute pancreatitis admitted to our center from January 2015 to May 2019 were included in the study and were divided into the training (n =566) and validation (n = 242) cohorts randomly, in a 2:1 ratio. The least absolute shrinkage and selection operator (LASSO) regression was used for data dimension reduction and feature selection; then, multivariable logistic regression analysis was used to develop the prediction model. The performance of this nomogram was evaluated with calibration and validated in the validation set. Decision curve analysis was applied to evaluate the clinical usefulness of this model. Results: Five potential predictors (BMI, RANSON score, serum uric acid, triglycerides and lactate) from 53 high‑dimensional clinical variables were incorporated to develop the prediction model of acute kidney injury. The nomogram demonstrated valuable prediction performance with AUROC of 0.994 and 0.996 in the training and validation cohorts, respectively. Individual risk probability was visually scored. The nomogram achieved fine calibration and good clinical usefulness. Conclusions: The proposed nomogram can help to identify high-risk population of acute kidney injury in patients with acute pancreatitis and facilitate timely individualized clinical decision‑making. Keywords: acute kidney injury; acute pancreatitis; risk factor; nomogram

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Section: Discussionmentioning

confidence: 99%

Development and validation of a predictive model for predicting acute kidney injury in patients with acute pancreatitis

Yang¹,

Kang²,

Wen³

et al. 2020

Preprint

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“…Although many conditions and drugs may aggravate polygenic HTG, surveys of the acquired factors present in cohorts with severe HTG or with HTG pancreatitis have highlighted the importance of overweight and obesity, diabetes, excessive alcohol consumption, and chronic renal disease, often complicated by triglyceride-raising medications (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Demographic and sociocultural factors have important effects as well (36). It is important to identify any and all modifiable aggravating factors because dietary and currently available pharmacologic interventions to lower triglyceride levels in individuals with CS may not be sufficient unless aggravating factors are removed or minimized, particularly over time.…”

Section: Clinical Conditions and Medications Associated With Developmmentioning

confidence: 99%

“…The prevalence of diabetes in reports of cohorts with severe HTG varies widely, ranging from 25% to 76% in reported studies (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). In a recent large US County Health System survey of risk factors for very severe HTG (triglyceride levels >2,000 mg/ dl) in whom most of the identified patients were Hispanic, diabetes was present in 76% (78 out of 103 cases) and was also frequently present in those with other secondary factors, such as obesity, excessive alcohol intake and use of triglyceride-raising drugs (25).…”

Section: Diabetesmentioning

confidence: 99%

“…Surveys of severe HTG indicate that up to 50% of patients are obese (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)50). However many of these subjects have other risk factors for HTG such as diabetes or alcohol excess, and obesity is associated with an increased occurrence of biliary disease which is a common cause of pancreatitis, so that the exact role of obesity in the genesis of CS and risk of pancreatitis is unclear.…”

Section: Obesitymentioning

confidence: 99%

“…Alcohol has been shown to stimulate VLDL secretion possibly through enhanced assembly of VLDL, combined with elevated hepatic delivery of free fatty acids as a results of enhanced adipose tissue lipolysis (55,56). In addition, there is evidence for a prolonged postprandial lipemic response due to decreased LPL activity although LPL activity has also been reported to be increased by chronic alcohol intake (57) Excessive alcohol intake was found to be present in 9% to 50% of individuals with severe HTG and may coexist with obesity and diabetes (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) and in studies of the prevalence of secondary factors in cohorts with very severe HTG, excessive alcohol intake was the second most common secondary factor after diabetes (25,45), accounting for 11% of potential causes of HTG in addition to a familial disorder (45). In a Dutch retrospective survey of subjects with severe HTG, excessive alcohol intake was more likely to be present in those with triglyceride levels >15.9 mmol/L (>1450 mg/dl) and especially >26.8 mmol/L (>2365 mg/ dl) (58).…”

Section: Alcohol Excessmentioning

confidence: 99%

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A Comprehensive Update on the Chylomicronemia Syndrome

Goldberg

Chait

2020

Front. Endocrinol.

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The chylomicronemia syndrome is characterized by severe hypertriglyceridemia and fasting chylomicronemia and predisposes affected individuals to acute pancreatitis. When due to very rare monogenic mutations in the genes encoding the enzyme, lipoprotein lipase, or its regulators, APOC2, APOA5, GPIHBP1, and LMF1, it is referred to as the familial chylomicronemia syndrome. Much more frequently, the chylomicronemia syndrome results from a cluster of minor genetic variants causing polygenic hypertriglyceridemia, which is exacerbated by conditions or medications which increase triglyceride levels beyond the saturation point of triglyceride removal systems. This situation is termed the multifactorial chylomicronemia syndrome. These aggravating factors include common conditions such as uncontrolled diabetes, overweight and obesity, alcohol excess, chronic kidney disease and pregnancy and several medications, including diuretics, non-selective beta blockers, estrogenic compounds, corticosteroids, protease inhibitors, immunosuppressives, antipsychotics, antidepressants, retinoids, L-asparaginase, and propofol. A third uncommon cause of the chylomicronemia syndrome is familial forms of partial lipodystrophy. Development of pancreatitis is the most feared complication of the chylomicronemia syndrome, but the risk of cardiovascular disease as well as non-alcoholic steatohepatitis is also increased. Treatment consists of dietary fat restriction and weight reduction combined with the use of triglyceride lowering medications such as fibrates, omega 3 fatty acids and niacin. Effective management of aggravating factors such as improving diabetes control, discontinuing alcohol and replacing or reducing the dose of medications that raise triglyceride levels is essential. Importantly, many if not most cases of the chylomicronemia syndrome can be prevented by effective identification of polygenic hypertriglyceridemia in people with conditions that increase its likelihood or before starting medications that may increase triglyceride levels. Several new pharmacotherapeutic agents are being tested that are likely to considerably improve treatment of hypertriglyceridemia in people at risk.

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Secondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis

Qureshi

Khan

Javaid

et al. 2021

The American Journal of the Medical Sciences

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Acute Pancreatitis in Patients With Severe Hypertriglyceridemia in a Multi-Ethnic Minority Population

Cited by 26 publications

References 18 publications

Development and validation of a predictive model for predicting acute kidney injury in patients with acute pancreatitis

Development and validation of a predictive model for predicting acute kidney injury in patients with acute pancreatitis

A Comprehensive Update on the Chylomicronemia Syndrome

Secondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis

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