Abstract
Background: Hypertriglyceridemia-associated acute pancreatitis (HTGAP) has been linked with increased severity and morbidity. In this study, triglyceride levels were measured in all patients admitted with acute pancreatitis (AP) to establish the incidence of HTGAP in an Australian center. Methods: A prospective cohort with AP was collated over an 18-month period in a single tertiary referral hospital. HTGAP was defined as AP with triglycerides ≥ 11.2 mmol/L (1000 mg/dL). Incidence, clinical co-morbidities, severity and management strategies were recorded. Results: Of the 292 episodes of AP, 248 (85%) had triglycerides measured and were included. HTGAP was diagnosed in 10 of 248 (4%) AP cases. Type 2 diabetes, obesity, alcohol misuse and gallstones were common cofactors. The HTGAP group demonstrated severe hypertriglyceridemia compared to the non-HTGAP group (median 51 mmol/L vs. 1.3 mmol/L). Intensive care unit (ICU) admissions were significantly increased (odds ratio (OR) 16; 95% CI 4–62) in the HTGAP group (5/10 vs. 14/238 admissions, p < 0.001) and constituted 26% (5/19) of total ICU admissions for AP. Four patients received intravenous insulin with fasting and had a rapid reduction in triglyceride levels by 65–77% within 24 h; one patient had mild hypoglycemia secondary to therapy. Conclusion: HTGAP occurred in 4% of AP cases and was associated with higher risk of ICU admission. Intravenous insulin and fasting appear safe and efficacious for acutely lowering triglyceride levels in HTGAP.
Highlights
Hypertriglyceridemia-associated acute pancreatitis (HTGAP) is thought to account for 0.7–20% of acute pancreatitis (AP) cases and is associated with increased severity and morbidity [1,2,3,4,5,6,7,8,9,10]
Patients included in the HTGAP group were more likely to have a prior diagnosis of dyslipidemia (50% vs. 21%) or type 2 diabetes mellitus (60% vs. 15%)
Severe hypertriglyceridemia was present at admission in the HTGAP group (median 51 mmol/L (IQR 46.8) vs. 1.3 mmol/L (IQR 0.9) Non-HTGAP)
Summary
Hypertriglyceridemia-associated acute pancreatitis (HTGAP) is thought to account for 0.7–20% of acute pancreatitis (AP) cases and is associated with increased severity and morbidity [1,2,3,4,5,6,7,8,9,10]. Hyperviscosity due to high concentrations of larger chylomicrons is thought to impede blood flow to the pancreas, leading to further ischemia This causal role for FFA was demonstrated in canines, where infusion of FFAs into the canine pancreas directly led to oedema and hemorrhage [14]. Hypertriglyceridemia-associated acute pancreatitis (HTGAP) has been linked with increased severity and morbidity. Triglyceride levels were measured in all patients admitted with acute pancreatitis (AP) to establish the incidence of HTGAP in an Australian center. Intravenous insulin and fasting appear safe and efficacious for acutely lowering triglyceride levels in HTGAP
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