Management of Hypertriglyceridemia Induced Acute Pancreatitis

Garg, Rajat; Rustagi, Tarun

doi:10.1155/2018/4721357

Cited by 167 publications

(216 citation statements)

References 78 publications

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“…Furthermore, those found to have severe or very severe HTG on admission should be considered for transfer to referral centres and be given more active symptomatic treatment, such as aggressive intravenous hydration, insulin and heparin therapy, and aphaeresis. 27 Besides the primary findings, there were several additional notable observations in the present study. First, it was noted that no significant differences were present in the history of chronic alcohol or diabetes between TG categories or severity groups, which was different from the findings of Nawaz's study.…”

Section: Discussionsupporting

confidence: 64%

“…Serum TG level should be checked routinely and shortly after the presentation of a patient with signs and symptoms of pancreatitis. Furthermore, those found to have severe or very severe HTG on admission should be considered for transfer to referral centres and be given more active symptomatic treatment, such as aggressive intravenous hydration, insulin and heparin therapy, and aphaeresis …”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Guo

et al. 2019

Int J Clin Pract

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Background Hypertriglycaeridemia has been positively associated with the risk of acute pancreatitis, but whether increased triglyceride (TG) levels are related to the severity of pancreatitis remains unclear. The aim of this study was to assess the relationship between hyperlipidaemia and disease severity of hypertriglycaeridemic pancreatitis. Methods From 2016 to 2018, patients with hypertriglyceridaemic pancreatitis presented within 24 hours from symptom onset were retrospectively enrolled. The severity was classified by the Atlanta classification 2012. The demographic and clinical characteristics of patients were compared with respect to severity stratification and different TG categories, respectively. The relationships of admission TG levels and disease severity were assessed with Spearman's rank correlation test and Linear‐by‐Linear Association test. Results Among 256 patients included, 125 (48.8%) were diagnosed with mild (MAP), 76 (29.7%) with moderate (MSAP) and 55 (21.5%) with severe acute pancreatitis (SAP). The mean TGs (standard derivation) on admission in patients with MAP, MSAP and SAP were 21.6 (15.2) mmol/L (1913 [1346] mg/dL), 34.6 (22.6) mmol/L (3065 [2002] mg/dL) and 41.5 (32.5) mmol/L (3676 [2879] mg/dL), respectively (P < .001). Patients were then categorised based on their TG levels. TG categories had a strong positive correlation with the disease severity (Rho = 0.34, P < .001). Positive trend for the association across increasing TG categories and SAP was observed (P < .001). Conclusions Elevated serum TG levels at the time of admission seem to correlate positively with the severity of hypertriglyceridaemia‐induced acute pancreatitis.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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

Zhang

Guo

et al. 2019

Int J Clin Pract

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“…Therefore, rapid reduction of serum TG levels during the early onset of the disease and the maintenance of serum TG at levels <5.65 mmol/l may prevent the progression of HTGAP (9). In current clinical practice, insulin and/or PE are commonly used as TG-lowering therapies for HTGAP (21,22); however, to the best of our knowledge, there are currently no uniform, standardized and comprehensive therapeutic guidelines for patients with HTGAP.…”

Section: Discussionmentioning

confidence: 99%

Effects of different triglyceride‑lowering therapies in patients with hypertriglyceridemia‑induced acute pancreatitis

Yao

Xia

et al. 2020

Exp Ther Med

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The aim of the present study was to investigate the effects of various triglyceride (TG)-lowering therapies on hypertriglyceridemia-induced acute pancreatitis (HTGAP). A total of 132 patients with HTGAP were retrospectively divided into an insulin intensive therapy (IIT), a plasma exchange (PE) and a non-intensive insulin therapy (NIIT) group according to the TG-lowering therapies they had received. The clinical and biochemical data of the subjects were analyzed. The baseline data, including sex, age, TG, amylase, severe acute pancreatitis and systemic inflammatory response syndrome were not significantly different among the three groups (P>0.05). The 24-h TG clearance rate (χ 2 =7.74, P=0.021), onset to treatment time (χ 2 =14.50, P<0.001) and the time required to reach the target TG level (χ 2 =6.12, P=0.047) were different in these three groups, but no significant differences were observed between the IIT and NIIT groups (P>0.05). The incidence of therapy-associated complications in the PE group (30.23%) was higher than that in the IIT (2.17%) and NIIT (4.65%) groups. The difference in the incidence of therapy-associated complications was significant among the three groups (P<0.001), but no significant difference was present between the IIT and NIIT groups (P>0.05). In the PE group, the length of stay was increased compared with that in the IIT and NIIT groups (χ 2 =7.05, P<0.05), while there was no significant difference between the IIT and NIIT groups (P>0.05). The present study suggested that NIIT at presentation had a similar therapeutic efficacy to that of IIT to improve the prognosis of HTGAP, and NIIT and IIT were associated with fewer complications than PE treatment. NIIT may favorably perform in patients presenting early after symptom onset and may be considered for clinical application.

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“…The most critical intervention is lifestyle modifications, including weight loss, a diet low in fat and high in omega‐3 fatty acids, cessation of alcohol, and aggressive control of other comorbid conditions, such as diabetes mellitus . Avoiding medications that alter the TG metabolism and may provoke HGAP, such as estrogen, steroids, interferon, isotretinoin, or tamoxifen, should be attempted . Antilipemic agents play a critical role in reducing the incidence of HGAP .…”

Section: Cases and Discussionmentioning

confidence: 99%

“…Avoiding medications that alter the TG metabolism and may provoke HGAP, such as estrogen, steroids, interferon, isotretinoin, or tamoxifen, should be attempted . Antilipemic agents play a critical role in reducing the incidence of HGAP . The goal with antilipemic agents is to achieve a TG level < 500 mg/dL to prevent recurrent episodes of HGAP .…”

Section: Cases and Discussionmentioning

confidence: 99%

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

Joury

Alshehri

Mahendra

et al. 2019

J of Clinical Apheresis

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Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE. K E Y W O R D S hypertriglyceridemia, pancreatitis, therapeutic plasma exchange

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Management of Hypertriglyceridemia Induced Acute Pancreatitis

Cited by 167 publications

References 78 publications

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

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

Effects of different triglyceride‑lowering therapies in patients with hypertriglyceridemia‑induced acute pancreatitis

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

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