Dyslipidaemic Pancreatitis Clinical Assessment and Analysis of Disease Severity and Outcomes

Abstract

Introduction: The relationship between pancreatitis and dyslipidaemia is unclear. Patients and Methods: Admissions with acute pancreatitis were prospectively evaluated. A comparison of the demographic profile, aetiology, disease severity scores, complications and deaths was made in relationship to the lipid profiles. Results: From June 2001 to May 2005, there were 230 admissions. The pancreatitis was associated with alcohol (63%), gallstones (18%), idiopathic (9%) and isolated dyslipidaemia (10%). Dyslipidaemia was significantly different between the two predominant race groups: Indian 50.5% and African 17.9% (p < 0.000017). Seventy-eight (34%) had associated dyslipidaemia and 152 (66%) were normolipaemic at admission. The average body mass index was higher in the dyslipidaemic group (27 ± 6) than in the normolipaemic group (24.5 ± 6.20; p = 0.004). The mortality rate was similar between the dyslipidaemic and normolipaemic patients (10 and 8%, respectively) and unrelated to race (p = 0.58). The 9 deaths in the dyslipidaemic group occurred in those with persistent hypertriglyceridaemia irrespective of its level (p = 0.003). Conclusion: Dyslipidaemic pancreatitis was more common in the Indian ethnic group. Adverse outcomes in those with dyslipidaemia were predominantly associated with hypertriglyceridaemia.

Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases

“…Therefore, the causes of HTG may be categorized into primary disorders (genetically based) such as lipoprotein lipase (LPL) and apolipoprotein C-II deficiency, which are usually present in childhood as chylomicronemia syndromes, and secondary disorders such as obesity, untreated diabetes mellitus, alcoholism, pregnancy, drugs associated (estrogens, glucocorticoids, and thiazide diuretics) or lithiasis. Abnormalities of insulin responsiveness are present in some of these cases (3,14). The association of SHTG and AP was first postulated by Speck in 1865 (15).…”

“…SHTG is reported to account for up to 10% of all AP episodes (16). It is generally believed that TG levels of >1000 mg/dl are a greater risk factor for AP (3). This threshold is arbitrary and the level above which AP might occur is actually unknown (4).…”

Klinikinis Atvejis: Hiperlipideminis Pankreatitas

“…Atlikta fibrogastroduodenoskopija, išvada: tulžies refliukso požymiai, eriteminė gastropatija, eriteminis duadenitas (galima reakcija dėl kasos patologijos). Kraujo tyrimai: padidėjęs amilazės (672 U/l) ir lipazės (824 U/l) aktyvumas, hiperglikemija (17,28 mmol/l), CRB 415,79 mg/l, ALT, AST ir kreatinino kiekis neišmatuojami dėl ryškios hiperlipemijos (++++). Šlapimo tyrimas: gliukozė šlapime 28 mmol/l, ketonai šlapime 5 mmol/l (++).…”

“…HTG diagnozuojama, kai TG kiekis kraujyje yra >1,69 mmol/l (150 mg/dL), sunki -daugiau kaip 22,6 mmol/l (2000 mg/dL) [19]. Vien pirminė HTG (šeiminė, genetiškai nustatyta) yra reta HP priežastis [17][18]. HP savarankiškai gali sukelti I dislipidemijos tipas (šeiminė chilomikronemija; paveldima autosominiu recesyviniu būdu) pagal Fredrickson'o klasifikaciją (HTG -dėl lipoproteinlipazės ir apolipoproteino C-II defekto), kuris dažniausiai diagnozuojamas ankstyvoje vaikystėje ir yra labai retas (1/1000000).…”

Nutritional advice for prevention of acute pancreatitis: review of current opinion

“…It was also observed that adverse outcomes in patients with dyslipidemia were seen in hypertriglyceridemia, even though past studies did not see this relationship. 39,40 In cases of acquired hypertriglyceridemia, patients with a pre-existing lipid abnormality can develop pancreatitis in the setting of a secondary factor such as poorly controlled diabetes, alcohol use, or intake of medication such as estrogens and beta-blockers. 37 Control of triglyceride levels can prevent additional attacks of pancreatitis, specifically if levels are less than 1000 mg/dL.…”