108 Hypertriglyceridemia-Induced Pancreatitis Results in Favorable Outcomes Despite Greater Predicted Severity on Admission

Abstract

INTRODUCTION: Hypertriglyceridemia-induced acute pancreatitis (HP) has been reported to have a more severe presentation and clinical course compared to other types of pancreatitis. Our aim was to determine if HP has a different predicted and actual clinical course than pancreatitis from other etiologies. METHODS: We analyzed a cohort of 455 consecutive patients admitted for acute pancreatitis to the Los Angeles County (LAC) Hospital between March 2015 and March 2017. Comprehensive characterization included pancreatitis etiology, substance use history, biochemical profile, and detailed clinical course. Predicted severity was defined using the Glasgow, Ranson, Pancreatitis Activity Scoring System (PASS), and systemic inflammatory response syndrome (SIRS) scores. Clinical outcomes included the development of local complications (pseudocyst, necrosis, walled-off necrosis), SIRS, organ failure, length of hospitalization, and days until oral nutrition tolerated. At LAC, patients with HP are admitted to a monitored care unit and managed with aggressive hydration and insulin. They are followed by endocrinology for lipid control and by hematology to initiate plasmapheresis if indicated. RESULTS: HP was identified in 17 patients and was the fifth most common etiology, behind gallstones (N = 219), alcohol (N = 120), medication-induced (N = 38), and idiopathic pancreatitis (N = 20) (Figure 1). HP patients had an average age of 37 with 71% having diabetes. HP patients were more likely to have had a prior history of pancreatitis (OR 13.5, 95% CI 4.6–39). HP patients were predicted to have more severe disease at admission based on the Glasgow and PASS scores and were more likely to have SIRS on admission (OR 5.7, CI 2.0–15.8). Despite having greater predicted severity, logistic regression analysis revealed that patients with HP were not more likely to develop local complications, SIRS after admission, or organ failure. Linear regression modeling also indicated that HP patients did not have a significantly longer length of hospitalization or time to tolerate oral intake (Table 1). CONCLUSION: Hypertriglyceridemia-induced acute pancreatitis patients are more likely to have SIRS on admission and are predicted to have a more severe clinical course based on validated scoring systems. However, with close multidisciplinary management including endocrinology and hematology consultations when indicated, these patients do not have a more adverse course relative to those with pancreatitis from other etiologies.