Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study.

Alfred Adiamah,I.J Beckingham,Martin Crook,M Shaw,Adam J Brooks,D Gomez,Sue Tumilty,Dileep N Lobo,A Koh,E Alabraba,I.C Cameron,A.P Navarro,Yuuki Na,G.R Irving,Anisa Kushairi,E Psaltis

doi:10.1016/j.clnesp.2020.06.008

Abstract

SummaryBackground and aimsHypertriglyceridaemia is both a primary cause of acute pancreatitis and an epiphenomenon. This study aimed to define the associations between hypertriglyceridaemia and clinical outcomes in patients admitted with acute pancreatitis.MethodsThis single-centre prospective observational study included patients with a confirmed clinical, biochemical or radiological diagnosis of acute pancreatitis from August 2017 to September 2018. Baseline demographics, aetiology of pancreatitis, and fasting triglyceride concentrations were recorded and assessed against the surrogate markers of severity: admission to critical care, length of stay (LOS), readmission to hospital, and mortality.ResultsIn total, 304 patients with a mean ± SD age of 56.1 ± 19.7 years met the inclusion criteria. There were 217 (71.4%) patients with normotriglyceridaemia (<150 mg/dL or <1.7 mmol/L), 47 (15.5%) with mild hypertriglyceridaemia (150–199 mg/dL or 1.7–2.25 mmol/L) and 40 (13.2%) with moderate-to-severe hypertriglyceridaemia (≥200 mg/dL or >2.25 mmol/L). The underlying aetiologies of acute pancreatitis were gallstones (55%), alcohol (18%), idiopathic (15%), hypertriglyceridaemia (9%), iatrogenic (2%) and bile duct abnormalities (1%). Patients with hypertriglyceridaemia were younger than those with normotriglyceridaemia (p < 0.05). On multivariate regression, moderate-to-severe hypertriglyceridaemia (OR 5.66, 95% CI: 1.87 to 17.19, p = 0.002) and an elevated C-reactive protein concentration ≥120 mg/L (OR 1.00, 95% CI: 1.00–1.01, p = 0.040) were associated with admission to critical care. Moderate-to-severe hypertriglyceridaemia was also associated with an increased LOS (p = 0.002) but not readmission (p = 0.752) or mortality (p = 0.069).ConclusionModerate-to-severe hypertriglyceridaemia in all aetiological causes of acute pancreatitis was predictive of admission to critical care and prolonged LOS but not readmission or mortality.

Highlights

Severe hypertriglyceridaemia refers to serum concentrations !1000 mg/ dL (11.3 mmol/L) and 15e20% of patients identified as having severe hypertriglyceridaemia develop acute pancreatitis [2]
304 patients with a mean ± SD age of 56.1 ± 19.7 years met the inclusion criteria: 217 (71.4%) patients were in the normotriglyceridaemia group, 47 (15.5%) patients in the mild hypertriglyceridaemia group and 40 (13.2%) patients were in the moderate-to-severe hypertriglyceridaemia group (Table 2)
There was a greater proportion of male patients in the hypertriglyceriademia groups compared with those in the normotriglyceridaemia group

Summary

Introduction

Deng et al found that on univariate analysis of patients with severe acute pancreatitis, those with hypertriglyceridaemia had a significant risk of mortality (13.1%) compared with patients with normotriglyceridaemia [8]. Hypertriglyceridaemia is both a primary cause of acute pancreatitis and an epiphenomenon. Aetiology of pancreatitis, and fasting triglyceride concentrations were recorded and assessed against the surrogate markers of severity: admission to critical care, length of stay (LOS), readmission to hospital, and mortality. Conclusion: Moderate-to-severe hypertriglyceridaemia in all aetiological causes of acute pancreatitis was predictive of admission to critical care and prolonged LOS but not readmission or mortality.

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