External Validation of a Predictive Model for Acute Pancreatitis Risk in Patients with Severe Hypertriglyceridemia

Abstract

Objective: We previously developed a predictive model to assess the risk of developing acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG). In this study, we aimed to externally validate this model. Methods: The validation cohort included cross-sectional data between 2013 and 2017. Adult patients (≥18 yearsold) with triglyceride levels ≥ 1,000 mg/dL were identified. Based on our previous four factors-predictive model (age, TG, excessive alcohol use, and gallstone disease), we estimated the probability of developing AP. Model performance was assessed using area under receiver operating characteristic curve (AUROC). Results: In comparison to the original cohort, patients in the validation cohort had more prevalent acute pancreatitis (16.2% vs 9.2%, p<0.001) and gallstone disease (7.5% vs 2.1%, p<0.001). Other characteristics were comparable and not statistically significant. The AUROCs were almost identical: 0.8337 versus 0.8336 in the validation and the original cohorts respectively. In univariable analyses, the highest increase in odds of AP was associated with HTG, followed by gallstones, excessive alcohol use, and younger age. Conclusion: This study externally validates the four-factor predictive model to estimate the risk of AP in adult patients with severe HTG (TG ≥ 1,000 mg/dL). Younger age was confirmed to place patients at high risk of AP. The clinical risk categories suggested in this study may be useful to guide treatment options.

Incidence, predictors and patterns of care of patients with very severe hypertriglyceridemia in Ontario, Canada: a population-based cohort study

“…Pancreatitis rates in individuals with VS-HTG (4.1% within 1 year, 6% within 2 years) were within the range of expectation based on other reports [ 27 ]. There was no apparent excess risk of atherosclerotic cardiovascular disease within the VS-HTG cohort at baseline or within the 2-year follow up period.…”

Lipaemic blood: alcohol-induced acute hypertriglyceridaemia

“…Using a validated predictive model for acute pancreatitis risk in patients with severe HT and taking into account risk factors such as age, presence or absence of excessive alcohol use and gallstone disease, the predicted risk of developing acute pancreatitis with excess alcohol use and serum TGs <1000 mg/dL is <4%. 1 Additionally, applying the same validated predicative model for acute pancreatitis in our younger patient predicted a high risk of >12% for development of acute pancreatitis with his serum TG >2000 mg/dL and excess alcohol use.…”

Hypertriglyceridaemia: a commentary

“…Much like the chronic prevention, the acute management of HTG-AP is also largely empirical driven by observational data with no supporting clinical trials. The importance of fat restriction is underappreciated and although often featuring in guidelines there has no clinical trials to support the routine use of insulin, heparin, albumin or plasmapheresis 38 39. Conservative management of AP-HTG has shown a mean decrease of TG of 70% by 48 hours similar to published figures for plasma exchange TG clearance, giving a TG half-life clearance of 30.6 hours 40…”

“…It is clear that the risk is not just about the HTG but also involves other factors such as age, sex, diabetes mellitus, alcohol use, obesity and inflammation 36 37. A risk score has been derived and validated to predict HTG-AP with the highest risk being in young males, with HTG±alcohol or gallstone disease reflecting other cohort studies 38…”