Factors associated with the severity of hypertriglyceridemia induced acute pancreatitis

Abstract

Hypertriglyceridemia induced acute pancreatitis (HTGP) was associated with increased risk of local complications, recurrent acute pancreatitis (AP), the frequency of other complications, and its high mortality as compared to other causes. Determining the factors associated with the severity of HTGP was necessary and important in the management of patients with AP.This study aims to examine the clinical and biochemical characteristics of HTGP patients, and to determine the factors associated with the severity of HTGP according to the revised Atlanta classification.This retrospective and prospective study enrolled 157 HTGP patients from January 2016 to May 2019 at Cho Ray Hospital who had serum TG levels measured within the first 48 hours of admittance with a TG concentration ≥ 1000 mg/dL and excluded other causes. The clinical features and outcomes of patients with HTGP were determined in terms of demographics, clinical symptoms, laboratory data, system complications, local complications, disease severity, and length of hospital stay. The primary outcome was the severity of HTGP as based according to the revised Atlanta classification. We evaluated the relationship between general information, clinical factors and laboratory data in the study population.There were 157 HTGP patients participated in this study. Patients with HTGP had evidence of obese or overweight range (61.2%), history of diabetes mellitus (32.5%) or undiagnosed diabetes (28.0%), history of AP (35.7%), alcohol use (23.6%), hypertension (15.9%), dyslipidemia (13.4%). The patients had typical symptoms of AP, including pancreatic abdominal pain (upper abdominal pain) (93%), nausea/vomiting (80.9%), fever (59.2%), distension abdomen (84.7%), and resistance of abdominal wall (24.8%). The severity of HTGP was significantly associated with fever, altered mental status, rapid pulse, and hypotension (P < .05). Patients with severe HTGP had significantly more pancreatic necrosis, higher values of Blood urea nitrogen and creatinine, longer prothrombin time and activated partial thromboplastin time on admission and higher CRP48 than not severe HTGP (P < .05).The severity of HTGP was significantly related to clinical factors including fever, altered mental status, rapid pulse, hypotension, and pancreatic necrosis. The value of Blood urea nitrogen, creatinine, prothrombin time, and activated partial thromboplastin time at admission is higher and longer in the severe AP group with P < .05.

Analyses of familial chylomicronemia syndrome in Pereira, Colombia 2010–2020: a cross-sectional study

“…It is estimated that up to 85% of patients with severe HTG of any etiology will develop AP at some point in their life [ 30 ]. According to Retterstøl, K., et al, the prevalence of a history of AP is 17% in patients with severe HTG [ 18 ].…”

“…Thong et al found in a study that in a population with very severe HTG, 13.4% of patients with HTG-induced acute pancreatitis had dyslipidemia, 15.9% presented hypertension and 28% had type 2 diabetes mellitus [ 30 ]. In the present study, 49.28, 32.43, and 19.6% of patients were identified with dyslipidemia, hypertension, and DM2, respectively.…”

Recurrent seasonal severe hypertriglyceridemia-induced acute pancreatitis; a case report

“…The literature is conflicting regarding the severity of HTG-AP when compared to other etiologies. However, many studies point out that HTG-AP causes the most severe form of AP with an increased risk of complications and mortality [ 2 , 14 ].…”

“…Acute pancreatitis (AP) is a serious inflammatory condition of the pancreas associated with severe morbidity and mortality [ 1 ]. It is a highly prevalent gastrointestinal condition and one of the leading causes of hospitalization, with an incidence of 4/10,000 in western countries and rising [ 2 , 3 ]. Excessive alcohol use and gallstones are the most frequent etiologies for AP, constituting 80–90% of the cases [ 4 ].…”

Development and validation of a risk prediction score for the severity of acute hypertriglyceridemic pancreatitis in Chinese patients

“…Clinical signs included continuous variables: Respiratory rate (RR), heart rate (HR), systolic blood pressure, and diastolic blood pressure. Laboratory findings performed within 24 h of admission included WBC, NLR[ 14 ], RDW[ 19 ], platelet counts (PLT), mean platelet volume (MPV)[ 20 ], platelet distribution width (PDW)[ 21 ], total cholesterol (TC)[ 22 ], TG[ 6 ], high-density lipoprotein cholesterol level to low-density lipoprotein cholesterol level ratio (H/L ratio)[ 23 ], apolipoprotein A1 (ApoA1)[ 24 ], total bilirubin (TBIL), aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), albumin (ALB)[ 25 ], blood urea nitrogen (BUN)[ 24 ], serum creatinine (Cr)[ 26 ], free triiodothyronine (fT3)[ 27 ], CRP, procalcitonin (PCT), serum sodium (Na), serum potassium (K), serum Ca 2+ , prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB)[ 28 ], and D-dimer levels[ 29 ]. Imaging results included the presence of a pleural effusion according to the chest X-ray within 24 h of admission[ 30 ].…”