Stratified analysis and clinical significance of elevated serum triglyceride levels in early acute pancreatitis: a retrospective study

Jianhua Wan,Yin Zhu,Yong Zhu,Wenhua He,Liang Xia,Pi Liu,Hao Zeng,Nonghua Lu

doi:10.1186/s12944-017-0517-3

Abstract

BackgroundHypertriglyceridemia is one of the three most common causes of AP, which is associated with the AP prognosis that has not been clearly defined.MethodsIn this retrospective study, 1539 AP patients, who had serum triglyceride (TG) levels measured within the first 72 h, were assessed. The study groups consisted of patients with normal, mild, moderate, and severe/very severe HTG levels based on the Endocrine Society Clinical Practice Guidelines. We collected baseline demographic information, laboratory values, complications, and clinical outcome data in different HTG severity groups to analyze the clinical significance of elevated TG levels in AP.ResultsOur study included 1539 AP patients; of these, 1078 (70%) had a normal TG levels, and 461 (30%) had elevated TG levels. The rates of severe AP increased in HTG groups of increasing severity (4% vs. 8% vs. 12%; Ptrend < 0.001). acute necrotic collection (ANC) and pancreatic necrosis developed in 32 and 39 of 112 patients (29% and 35%) (Ptrend = 0.001; Ptrend = 0.001) in the severe/very severe HTG group, respectively. The proportion of persistent organ failure (POF), multiple organ failure (MOF), and persistent Systemic Inflammatory Response Syndrome (SIRS) increased with higher grades of HTG (Ptrend < 0.001; Ptrend < 0.001; Ptrend < 0.001). The ICU admission rate was higher in the severe/very severe HTG group (57/112 patients; 51%; Ptrend < 0.001). A logistic multivariate regression analysis showed a positive correlation between HTG and certain AP complications.ConclusionIn addition to other factors, an elevated TG level could be associated with the severity and prognosis of AP, including pancreatic necrosis, POF, MOF, persistent SIRS, ICU admission, and mortality.

Highlights

Hypertriglyceridemia is one of the three most common causes of Acute pancreatitis (AP), which is associated with the AP prognosis that has not been clearly defined
A higher proportion of acute biliary pancreatitis was observed in the normal TG group, and more cases of alcoholic and HTG pancreatitis were found in the HTG group
A higher proportion of AP patients succumbed to their illness in the severe acute pancreatitis (SAP) group than in the moderately severe AP (MSAP) and Mild acute pancreatitis (MAP) groups (16% vs. 4% vs. 1%; Ptrend < 0.001)

Summary

Introduction

Hypertriglyceridemia is one of the three most common causes of AP, which is associated with the AP prognosis that has not been clearly defined. Acute pancreatitis (AP) is a complex inflammatory disease that locally involves the pancreas as well as systemic organs. Mild acute pancreatitis (MAP) often has a good prognosis; 15–20% of AP patients develop severe acute pancreatitis (SAP), which has higher morbidity and mortality rates. Clinical findings associated with a severe course in the initial risk assessment include patient age, body mass index, the presence of Systemic Inflammatory Response Syndrome (SIRS), signs of hypovolemia, such as an elevated blood urea nitrogen (BUN) and hematocrit (HCT), the presence of pleural effusions and/or infiltrates, altered mental status, and other factors [1]. Patients with hyperlipidemia acute pancreatitis (HLAP) show a higher mortality rate, more severe prognoses and more frequent local complications [3].

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