Hypertriglyceridemic acute pancreatitis in emergency department: Typical clinical features and genetic variants

Abstract

OBJECTIVE:To investigate the clinical characteristics of patients with hypertriglyceridemic acute pancreatitis (HTGAP), and the molecular foundation contributing to hypertriglyceridemia in such patients. METHODS:Clinical data from 329 patients with acute pancreatitis (AP) were analyzed. The patients were divided into the HTGAP group, with fasting serum triglyceride (TG) levels ≥500 mg/dL (5.65 mmol/L), and the non-HTGAP (NHTGAP) group. Targeted next-generation sequencing was applied to 11 HTGAP patients to identify the genetic mutations associated with hypertriglyceridemia, including apolipoprotein A-V (APOA5), APOC2, APOC3 and APOE, BLK, LPL, GPIHBP1 and LMF1. RESULTS:Patients in the HTGAP group, compared with those in the NHTGAP group, had a higher mortality rate (7.5% vs 0.7%, P = 0.001), more commonly seen severe AP (17.5% vs 5.2%, P = 0.004) as well as a higher recurrence rate (32.4% vs 19.9%, P = 0.070). DNA sequencing showed that two patients carried the same compound of p.G185C and p.V153M heterozygous mutations located in the APOA5 gene. Two patients carried a homozygous variation of p.C14F, in the GPIHBP1 gene. One patient had a homozygous variation of p.R176C in the APOE gene. And a rare heterozygous LMF1 gene mutation of p.P562R was detected in two patients.CONCLUSIONS: HTGAP was significantly severe than NHTGAP, with a high recurrence rate. Genetic information may be useful in the clinical setting for the investigation of the pathogenesis of HTGAP and its interventions.

Low FT3 is a valuable predictor of severe acute pancreatitis in the emergency department

“…The classification of the pancreatitis based on the severity was as follows . MAP was defined as AP without local or systemic complications or organ failure.…”

“…Biliary AP was diagnosed if cholelithiasis was identified by ultrasonography, plain or contrast‐enhanced CT, MRI or MRCP. Alcohol‐related AP was defined as previously described . Hypertriglycemic AP was diagnosed when the following criteria were met: (i) triglyceride (TG) ≥11.3 mmol/L; or (ii) TG ≥5.65 mmol/L with visible chylomicronemia.…”

“…Acute pancreatitis (AP) is an inflammatory process of the pancreas with retroperitoneal viscus and multiorgan involvement in moderate‐to‐severe cases. Patients with mild AP (MAP) often recover spontaneously within a few days; however, those with moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) may suffer local or systemic complications, or even die of multiorgan dysfunction syndrome (MODS) due to an aggravated inflammatory response . Notably, early SAP can progress within 72 h to MODS, which is characterized by fatal conditions such as abdominal compartment syndrome due to pancreatic or peripancreatic necrosis, cardiovascular failure, acute respiratory distress syndrome, acute kidney injury and infection .…”

Variants of Lipid-Related Genes in Adult Japanese Patients with Severe Hypertriglyceridemia

“…In this study, we investigated the prevalence and characteristics of serum triglyceride-related gene variants in adult Japanese patients with severe hypertriglyceridemia. Forty-nine genes reported to be associated with hypertriglyceridemia, including LPL, APOC2, GPIHBP1, APOA5, and LMF1, were analyzed by next-generation sequencing (NGS) 3,[6][7][8] .…”

Hypertriglyceridemia and obesity exacerbate the course of SIRS induced by SAP in Rats

“…Acute pancreatitis (AP) is a frequent inflammatory disease of the pancreas with multiple causes, among which hypertriglyceridemia is the third most common and accounts for up to approximately 10% of all cases (1). Clinical studies have reported that SAP patients with HTG and obesity suffer a more severe clinical course and complications, including aggravating systemic inflammatory response，multiple organ failure, infection and high mortality (2)(3)(4). Animal experiments have also provided evidence that HTG with SAP could exacerbate oedema and necrosis of the pancreas (5).…”