SEVERE HYPERTRIGLYCERIDEMIA, THE REALITY OF A UNIVERSITY HOSPITAL

Abstract

Objective: Severe hypertriglyceridemia (SHTG) is defined as a serum triglyceride (TG) level > 1000 mg/dL. It is a rare condition associated with serious complications, such as acute pancreatitis (AP). A paucity of published data exists evaluating management and outcome in SHTG. So, the best treatment is still a matter of discussion. The aim of this study is to outline the demographics, management and outcome (reoccurrence and mortality) in all patients with SHTG treated at a University hospital. Design and method: A retrospective, observational and analytical study was carried out, through the collection of data from the clinical files of patients with SHTG admitted to the Internal and Intensive Medicine Department between 1 January 2009 and 31 December 2020, in a level III hospital. Data were nalysed using the IBM SPSSstatistics program. Results: The sample included 17 patients. The most common complication was AP (70.6%), followed by decompensated diabetes mellitus (DM). 84.2% required admission to the Intensive Care Unit (ICU). Concerning the metabolic profile: 94% were overweight; 52.9% had previous dyslipidemia; 47.1% arterial hypertension and 52.9% type 2 DM. Among patients with AP, the most common therapies instituted were insulin (82.4%) and fibrates (76.5%). 58.8% required plasmapheresis, and a single session allowed, on average, a reduction of 56.8% in the value of TGs. The criteria for implementation were mainly clinical and laboratory, including lactic acidosis (58.8%) and renal dysfunction (23.5%). There were no deaths, the readmission rate was 36.3%, all due to AP. Conclusions: This study shows the morbidity associated with SHTG, with a high level of admissions to the ICU and performance of plasmapheresis. This allowed a significant reduction in TG values, with the clinical severity being the main criteria for its initiation. In our population, this approach was effective, and should be highlighted, as there are no clear international guidelines on this area. Our data do not allow us to distinguish between patients with familial chylomicronemia syndrome or with multifactorial chylomicronemia. The recent appearance of specific therapy for LPL genetic deficit makes it important, and in the future the genetic study should be considered.