Clinical Study of 224 Patients with Hypertriglyceridemia Pancreatitis

Abstract

Background:Hypertriglyceridemia (HTG) is the most common etiology of acute pancreatitis (AP) after alcohol and gallstone-induced disease. Elevation of serum triglyceride (TG) levels to ≥1000 mg/dl in a patient with AP strongly indicates HTG as the cause. The absolute risk of pancreatitis based on serum TG ≤1000 mg/dl has not been clearly defined. The aims of this study were to address the role of elevated TG levels between 500 and 1000 mg/dl in the clinical course of HTG pancreatitis (HTGP); and assess the relationship between the level of serum TG and disease severity.Methods:A total of 224 HTGP patients between 2007 and 2011 were divided into two subgroups. Totally, 122 patients in Group A had serum TG >1000 mg/dl; 102 patients in Group B had maximal TG levels between 500 and 1000 mg/dl accompanied by lactescent serum; 100 patients with biliary AP and 99 patients with alcoholic AP hospitalized during the study period were enrolled as controls. The clinical and biochemical data were analyzed.Results:The clinical presentation of HTG-induced pancreatitis was similar to other causes. Severe form of AP in Group A was higher than Group B (χ2 = 4.002, P = 0.045). The severity with HTGP was significantly higher as compared to biliary AP (χ2 = 33.533, P = 0.000) and alcoholic AP (χ2 = 7.179, P = 0.007). Systemic complications with HTGP were significantly higher than biliary AP (χ2 = 58.763, P = 0.000).Conclusions:The study demonstrated that TG level ≥500 mg/dl should raise a high degree of suspicion, especially if no other etiology of AP is apparent. The severity of HTGP seems to correlate directly with TG level. HTGP seems be more severe than other causes of AP.

Development of a novel model of hypertriglyceridemic acute pancreatitis in mice

“…we observed that AP severity was positively associated with serum triglyceride levels rather than the serum amylase levels (Fig. S5) and this was consistent with the clinical characteristics of HTG - AP1819. In view of the most remarkable injury of mice AP induced by high dose P-407, hence, we adopted the dose (0.5 g/kg) as the follow-up experiment research dose.…”

Elevated triglycerides on admission positively correlate with the severity of hypertriglyceridaemic pancreatitis

“…23 In this study, patients with AP who had a TG level of ≥11.3 mmol/L (1000 mg/dL) or between 5.65 and 11.3 mmol/L (500-1000 mg/dL) accompanied by lactescent serum in the absence of other obvious aetiology of pancreatitis were diagnosed with HTG-induced AP according to the Chinese guideline for AP and study of HTG-AP. 11,24,25 In this study, a severe course of disease with higher TG levels on admission was observed among patients with HTG-AP. Findings from the present study support and extend previous work in this area.…”

“…A retrospective study of 224 patients with HTG-AP showed that incidence of SAP in patients with TG levels >11.3 mmol/L (1000 mg/dL) was higher as compared with patients with TG levels of 5.65-11.3 mmol/L (500-1000 mg/dL). 24 However, not all studies have shown a consistent difference in the clinical course by the level of serum TG. 19,20 The present study provides further support for a significant trend towards severe AP 17 In view of the relationship between admission TG levels and disease severity, it is important for clinicians to identify these high-risk patients.…”

“…Besides, TG levels rapidly decrease to near normal levels within 72 hours of presentation in patients with HTG‐induced AP . In this study, patients with AP who had a TG level of ≥11.3 mmol/L (1000 mg/dL) or between 5.65 and 11.3 mmol/L (500‐1000 mg/dL) accompanied by lactescent serum in the absence of other obvious aetiology of pancreatitis were diagnosed with HTG‐induced AP according to the Chinese guideline for AP and study of HTG‐AP …”

“…Findings from the present study support and extend previous work in this area. A retrospective study of 224 patients with HTG‐AP showed that incidence of SAP in patients with TG levels >11.3 mmol/L (1000 mg/dL) was higher as compared with patients with TG levels of 5.65‐11.3 mmol/L (500‐1000 mg/dL) . Among AP patients with TG >11.3 mmol/L (1000 mg/dL), Wang et al reported statistically significant higher incidence of local complications, moderate to severe pancreatitis and ≥3 organ failures in patients with high TG levels (>29.9 mmol/L [2648 mg/dL]) as compared with the group with low TG levels (11.3‐29.9 mmol/L [1000‐2648 mg/dL]) .…”