Outcome benefit of abdominal paracentesis drainage for severe acute pancreatitis patients with serum triglyceride elevation by decreasing serum lipid metabolites.

Zhu Huang,Tao Chen,Jing Zhou,Tao Wang,Long Cheng,Li-Jun Tang,Hong-Tao Yan,Hong-Yin Liang,Wei-Hui Liu,Kui-Ying Wang,Sun-Hong Yu,Zhu-Lin Luo,Lin Ning

doi:10.1186/s12944-016-0276-6

Abstract

BackgroundOur previous reports demonstrated that abdominal paracentesis drainage (APD) exerts a beneficial effect on severe acute pancreatitis (SAP) patients. However, the underlying mechanisms for this effectiveness are not well understood.MethodsA retrospective cohort of 132 consecutive non-hypertriglyceridemia (HTG)-induced SAP patients with triglyceride (TG) elevation and pancreatitis-associated ascitic fluid (PAAF) was recruited from May 2010 to May 2015 and included in this study. The patients were divided into two groups: the APD group (n = 68) and the non-APD group (n = 64). The monitored parameters mainly included mortality, hospital stay, the incidence of further intervention, levels of serum lipid metabolites and inflammatory factors, parameters related to organ failure and infections, and severity scores.ResultsThe demographic data and severity scores were comparable between the two groups. Compared with the non-APD group, the primary outcomes (including mortality, hospital stay and the incidence of percutaneous catheter drainage) in the APD group were improved. The serum levels of lipid metabolites were significantly lower in the APD group after 2 weeks of treatment than in the non-APD group. Logistic regression analysis indicated that the decreased extent of free fatty acid (FFA)(odds ratio, 1.435; P = 0.015) was a predictor of clinical improvement after 2 weeks of treatment.ConclusionTreatment with APD benefits non-HTG-induced SAP patients with serum TG elevation by decreasing serum levels of FFA.

Highlights

Our previous reports demonstrated that abdominal paracentesis drainage (APD) exerts a beneficial effect on severe acute pancreatitis (SAP) patients
We aim to investigate (i) whether APD is beneficial to non-HTG-induced SAP patients with TG elevation; (ii) whether removing the pancreatitis-associated ascitic fluid (PAAF) and thereby removing the lipid metabolites in the fluids could reduce the level of lipid metabolites in plasma; (iii) whether the effectiveness of APD correlates with the reduction of lipid metabolites in plasma
The concentrations of lipid metabolites were not as high as those in plasma; this may be due to the consequent dilution of fluids into the abdominal cavity. These results suggest that the APD procedure could significantly decrease the levels of TG and free fatty acid (FFA) in plasma, and these variations in plasma might have a correlation with the drainage of PAAF

Summary

Introduction

Our previous reports demonstrated that abdominal paracentesis drainage (APD) exerts a beneficial effect on severe acute pancreatitis (SAP) patients. The possible mechanisms for the effectiveness of APD could come from two sources: 1) decreasing intraabdominal hypertension (IAH); 2) eliminating the toxic substances, mainly including inflammatory mediators, proteases and lipid metabolites in pancreatitis-associated ascitic fluid (PAAF). Among these substances, lipid metabolites, the reaction products of fat necrosis, have been demonstrated to be involved in the development and progression of pancreatitis [5,6,7,8]. FFA in necrotic collections generated from peri-pancreatic or visceral fat necrosis have been reported to be a possible mediator of the conversion of mild acute pancreatitis (AP) to SAP because of its ability to induce necroapoptosis and cause multi-system injury [6]

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