Hyperlipidemic Acute Pancreatitis Research Articles

The role of four criteria in assessment of the severity and prognosis of hyperlipidemic acute pancreatitis

To explore the four criteria, including bedside index for severity in acute pancreatitis(BISAP), Ranson score, modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring systemⅡ(APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis. A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015. The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve. The incidences of moderately severe acute pancreatitis and severe acute pancreatitis, local complications and mortality of patients with BISAP score≥3, Ranson score≥3, APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score<3, Ranson score<3, APACHE Ⅱscore<8 and MCTSI<4 respectively (all P<0.05). As far as severity was concerned, the sensitivity and AUC of APACHEⅡ were 57% and 0.814, which were higher than the other systems. The second most sensitive criterion was BISAP. In assessment of local complications, the sensitivity and AUC of MCTSI were 68% and 0.791, which were higher than the other three. The most sensitive criterion to predict mortality was BISAP with sensitivity 89% and AUC 0.867, which was followed by APACHE Ⅱ. All four criteria can be used to determine the severity, local complications and mortality. Generally, BISAP is simple and easy to practice, and better than the other three.

Comparison of BISAP, Ranson, MCTSI, and APACHE II in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients.

In recent years, with the developing of living standard, hyperlipidemia becomes the second major reason of acute pancreatitis. It is important to predict the severity and prognosis at early stage of hyperlipidemic acute pancreatitis (HLAP). We compared the BISAP, Ranson, MCTSI, and APACHE II scoring system in predicting MSAP and SAP, local complications, and mortality of HLAP. A total of 326 diagnosed hyperlipidemic acute pancreatitis patients from August 2006 to July 2015 were studied retrospectively. Our result showed that all four scoring systems can be used to predict the severity, local complications, and mortality of HLAP. Ranson did not have significant advantage in predicting severity and prognosis of HLAP compared to other three scoring systems. APACHE II was the best in predicting severity of HLAP, but it had shortcoming in predicting local complications. MCTSI had outstanding performance in predicting local complications, but it was poor in predicting severity and mortality. BISAP score had high accuracy in assessment of severity, local complications, and mortality of HLAP, but the accuracy still needs to be improved in the future.

Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis.

Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis.

Meta-analysis of aetiology and the severity of acute pancreatitis about Chinese clinical trials

Objective To investigate the characteristics of common causes of acute pancreatitis (AP) in China and to evaluate the association of the aetiology with the severity of disease. Methods The relevant literature was searched from the China National Knowledge Infrastructure (CNKI) database (1989.1-2015.3), WANFANG database (1999.1-2015.3), VIP database (1994.1-2015.3), and China Academic Journal Network Publishing Database (CAJD). To collect related literature about aetiology and the severity of acute pancreatitis, Meta analysis was performed for gallstone, alcohol, hyperlipidemia and other AP from the aspects of the severity of disease in the literature which reaches the criteria. Results The Meta analysis included 24 clinical articles which were accordance with the criteria, totally 17359 patients, including 8673 cases of biliary AP [6690 cases of mild acute pancreatitis (MAP), 1983 cases of acute necrotizing pancreatitis (ANP)], 1408 cases of alcoholic AP (1022 cases of MAP, 386 cases of ANP), 1753 cases of hyperlipidemia AP (1107 cases of MAP, 646 cases of ANP), and 5525 cases of other aetiology (4179 cases of MAP, 1346 cases of ANP). The Meta analysis showed that among the common causes which was developed to AP, there was significant difference between biliary AP and alcohol AP (OR=0.65, 95% CI: 0.45~0.93, P 0.05). Conclusions There is difference in the severity of AP caused by different reasons in China. There is more likely that hyperlipidemia AP and alcohol AP easily developed into ANP than biliary AP. However, further investigation and large-scale clinical trials will be needed to confirm this conclusion. Key words: Pancreatitis/ET; Meta-analysis

Effect of alprostadil combined with Salvia miltiorrhiza in treatment of hyperlipidemic acute pancreatitis

Objective To investigate the effect of alprostadil combined with Salvia miltiorrhiza in treatment of hyperlipidemic acute pancreatitis. Methods Patients with high cholesterol of hyperlipidemic acute pancreatitis were randomly divided into control group and treatment group, 32 cases in each group.The control group were treated with conventional therapy combined with alprostadil 10μg intravenous injection, the treatment group was given Salvia miltiorrhiza injection 20mL vein infusion on the basis of the control group.The abdominal pain relief time, APACHE-II, C reactive protein levels, prognosis, hospitalization time and cost were compared between the two groups. Results The abdominal pain relief time, APACHE-II score, C reactive protein level in the treatment group were (5.31±1.09)d, (2.34±1.18), (48.41±22.64)mg/L, which were better than those in the control group (8.16±1.39)d, (4, 47±1.68) and (65.34±18.02)mg/L, the differences were statistically significant (t=9.08, 0.14, 5.84, -0.49, 3.31, all P 0.05). The operation rate of control group was 31.25% (10/32), which was significantly higher than that of the treatment group [6.25%(2/10)], the total hospitalization time, total cost of the treatment group were (14.50±1.55)d and (4.97±1.00)ten thousand yuan, which were significantly lower than those of the control group (16.78±1.83) d and (5.72±1.71)ten thousand yuan, the differences were statistically significant (χ2=6.65, t=1.00, t=5.39, all P<0.05). Conclusion Alprostadil combined with Salvia miltiorrhiza injection in the treatment of hyperlipidemia hyperlipidemia acute pancreatitis is safe, has good treatment effect, and can shorten the course of disease, reduce patients' hospitalization time and cost, and effectively improve the cure rate. Key words: Pancreatitis; Hyperlipidemic; Alprostadil; Salvia miltiorrhiza

Different Clinical Presentations of Hyperlipidemic Acute Pancreatitis: A Retrospective Study.

The goal of this study was to summarize the clinical features of hyperlipidemic acute pancreatitis (HLAP), and help clinicians understand the characteristic presentations of HLAP. From July 2009 to June 2013, 1073 cases of acute pancreatitis were retrospectively assessed. The clinical characteristics of HLAP and non-HLAP were statistically analyzed. The etiologic ratio of HLAP in acute pancreatitis rose from 13% in 2009 to 25.6% in 2013. Diabetes mellitus, fatty liver, and acute pancreatitis recurrence were positively correlated with HLAP, and female sex, age (>60 years), and alkaline phosphatase level were negatively correlated with HLAP. The diagnostic accuracy of amylase in HLAP was only 40.38%, compared with lipase (91.83%). Different cutoff points of serum triglyceride on day 1 (5.33 mmol/L), day 2 (2.77 mmol/L), and day 3 (2.18 mmol/L) could be used to obtain an accurate diagnosis of HLAP. Higher incidences of acute peripancreatic fluid collection, renal failure, and severe acute pancreatitis were also observed in patients with HLAP. Different clinical presentations of HLAP should be applied to be distinguished from non-HLAP in the clinic.

Continuous Renal Replacement Therapy in Successful Treatment of a Patient With Hyperlipidemic Acute Pancreatitis

Continuous Renal Replacement Therapy in Successful Treatment of a Patient With Hyperlipidemic Acute Pancreatitis

Alprostadil combined with peritoneal lavage therapy for treatment of hyperlipidemic severe acute pancreatitis

Alprostadil combined with peritoneal lavage therapy for treatment of hyperlipidemic severe acute pancreatitis

Severity analyese of acute pancreatitis based on etiology

To explore the relationship between etiology and severity of acute pancreatitis (AP). A total of 486 AP patients, hospitalized at digestive, general surgery or critical care medicine departments from May 2012 to May 2014, were recruited retrospectively. And the data of clinical features, etiology and severity classification of AP according to the revised Atlanta criteria (2012) were collected. The relationships between different gender, age group, etiology and severity of disease were compared. The etiology distribution was as follows: gallstone (n = 296, 60.9%), hyperlipidemia (n = 93, 19.1%), alcohol (n = 48, 9.9%) and other causes (n = 49, 10.1%). And the severity was mild AP (MAP, n = 387, 79.6%), moderate-severe AP (MSAP, n = 53, 10.9%) and severe AP (SAP, n = 46, 9.5%). The proportion of females for gallstone AP was slightly higher than that of males (1.23: 1). However, for hyperlipidemic and alcoholic AP, the proportion of males was significantly higher than that of females (P = 0.00). The onset age of gallstone AP was generally over 40 years while hyperlipidemic and alcoholic AP tended to occur in patients aged under 60 years (P = 0.00). Among all age groups, the group of over 60 years had the highest MSAP incidence of 14% while <40-year-old group the highest incidence of SAP at 11.3%. And the >60-year-old group had the highest total incidence of MSAP and SAP at 22.2%. Compared with gallstone, alcohol and other causes, hyperlipidemic AP had a higher risk of MSAP and SAP (P = 0.028). Gallstone remains a leading cause of AP. Hyperlipidemic pancreatitis has shown a rising tendency in recent years and it often result in a more serious clinical process. And the clinicians should pay more attention to health education of patients.

Plasma exchange treatment for acute hyperlipidemic pancreatitis with falsely low levels of serum triglycerides – a case report

Hypertriglyceridemia is a well-recognized cause of acute pancreatitis. We present a patient with acute hypertriglyceridemic pancreatitis. At presentation serum triglycerides were severely elevated (104 mmol/l) and were decreasing the next day (11 mmol/l). However, based on increasing levels of serum lipase, worsening respiratory failure and evidently lipemic serum, we decided to perform plasma exchange, and patient's condition improved dramatically. Repeated laboratory test of the serum obtained before the first plasma exchange revealed that the actual value of serum triglycerides was 57 mmol/l. A clinically-driven decision is crucial when treating patients with hypertriglyceridemic acute pancreatitis as the serum triglyceride levels can be falsely low.

Clinical characteristics analysis of 2625 acute pancreatitis in Jiangxi Province

Objective To analyze the clinical characteristics of patients with acute pancreatitis (AP) in Jiangxi Province.Methods From 2007 to 2012,the data of 2 625 hospitalized patients diagnosed as AP were retrospectively analyzed.The changes of composition in gender,age and etiology during 2007-2009 time period and 2010-2012 time period were compared.Mann Whitney U test was performed for non-normal distribution measurement data analysis and x2 test was for count data analysis.Results Among the 2 625 patients with AP,from 2007 to 2009 there were 1 028 cases and 1 597 cases in the period 2010 to 2012.The ages of the patients in these two period were 50(38,61) and 50 (40,63) years old,respectively.There was statistically significant difference in the age distribution between these two period (U=783 635.5,P＜0.05).Biliary factor was the most common cause of AP in the two time period 2007 to 2009 and 2010 to 2012,which accounted for 55.9％ (575/1 028) and 62.9％ (1 005/1 597),respectively,and the difference was statistically significant (x2=12.778,P＜ 0.01).Alcoholic AP accounted for 1.9％ (19/1 028) and 7.3％ (117/1 597),respectively,hyperlipidemic AP were 14.0％ (144/1 028) and 17.7％ (283/1 597),and idiopathic AP were 22.0％ (226/1 028) and 5.9％ (94/1 597),all the differences were statistically significant (x2 =38.204,6.330 and 151.416,all P＜0.05).In male patients,biliary AP accounted for 52.4％ (732/1 398),which was lower than that of female patients (69.1％,848/1 227),and the difference was statistically significant (x2 ＝76.524,P＜0.01).Alcoholic AP and hyperlipidemic AP accounted for 9.0％ (126/1 398) and 21.4％ (299/1 398) in male patients,which were significantly higher than those of female patients (0.8％,10/1 227; 10.4％,128/1 227),and the differences were statistically significant (x2 89.396 and 57.585,both P＜0.01).Biliary AP accounted for 79.9％ (631/790) in elderly group,which was higher than that of non elderly group (51.7％,949/1 835),and the difference was statistically significant (x2＝182.720,P＜0.01).In elderly group hyperlipidemic AP and alcoholic AP accounted for 2.5％ (20/790) and 1.3％ (10/790),which were significantly lower than those of non-elderly group (22.2％,407/1 835; 6.9％,126/1 835),and the differences were statistically significant (x2 =156.524 and 35.262,both P＜0.01).Conclusions The middle-aged and elderly people are the vulnerable population of AP.Biliary factor is the most common cause of AP,especially in the female and elderly.The proportions of hyperlipidemic AP and alcoholic AP both significantly increase,in the male higher than that of the female and in the non-elderly higher than that of the elderly.The proportion of idiopathic AP significantly decreases. Key words: Acute pancreatitis; Clinical characteristics; Etiology

Incidence and Clinical Features of Hyperlipidemic Acute Pancreatitis From Guangdong, China

This study aimed to investigate the clinical features and incidence trends of hyperlipidemic acute pancreatitis (HLAP) of multicenter studies in Guangdong, China, for 15 years. The medical records of 1582 patients with acute pancreatitis who were admitted to 4 general hospitals of Guangdong from January 1990 to December 2005 were reviewed. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, and recurrence rate. A total of 7.8% (123/1582) patients met the HLAP criteria. Incidence of HLAP was approximately 2.6 times increased during 15 years (3.4% in 1990-1994, 5.9% in 1995-1999, and 8.9% in 2000-2005, respectively) and ranged from 3.3% to 15.5% in 4 hospitals across Guangdong. A history of diabetes was present in 31.7% and alcohol use in 18.7%. The mean (SD) triglyceride levels were 13.6 (7.2) mmol/L. Amylase was elevated higher than normal in 81.2% but only 2 times normal in 17.1% and 3 times normal in 37.6%. The frequency of severe acute pancreatitis, organ dysfunction, rate of recurrence, and mortality of HLAP was significantly higher than biliary-induced pancreatitis. The incidence of HLAP had significantly increased during the past 15 years with a clear geographic variation and remarkable severity and recurrent trend.

Hemodiafiltration Combined with Resin-Mediated Absorption as a Therapy for Hyperlipidemic Acute Pancreatitis

The aim of this study is to investigate whether hemodiafiltration combined with resin-mediated absorption is a better therapy for hyperlipidemic acute pancreatitis. Patients (n = 67) with acute pancreatitis treated in ICU from January 2009 to December 2012 were included in this study. Seven of these 67 cases were diagnosed hyperlipidemic acute pancreatitis (HLAP). All the 7 HLAP patients went through fast, gastrointestinal decompression, anti-shock treatment, inhibition of pancreatic secretion, antiseptic treatments, and hemoperfusion (HP) combined with continuous veno venous hemodiafiltration (CVVHDF). After one round of treatment by resin adsorption, there was a significant decrease in serum triglycerides (TG) (29.78 %) and total cholesterol (TC) (24.02 %) levels (p < 0.01). TG and TC levels dropped by 49.02 and 37.66 %, respectively, after 1-day treatment of HP + CVVHDF; by 62.81 and 47.37 % on day 2 post-treatment; and by 69.57 and 49.47 % on day 3 post-treatment. All the 7 patients survived. The average time spent in the ICU was 7 ± 3.8 days, and the average duration of hospitalization was 19 ± 15.1 days. Our results show that hemoperfusion combined with hemodiafiltration is an efficient treatment as this approach can reduce plasma lipid levels effectively and reduce the risk of acute pancreatitis due to hyperlipidemia.

Nursing experience of acute hyperlipidemic pancreatitis misdiagnosed as acute appendicitis

Objective To explore the appropriate nursing care of acute hyperlipidemic pancreatitis and increase nursing level.Methods The clinical data of 3 cases of hyperlipidemic pancreatitis misdiagnosed as acute appendicitis were analyzed retrospectively and the nursing experience was summarized.Results The blood sample of all 3 cases represented dramatically high level of serum triglyceride (14.1～61.0 mmol/L).Obvious inducing factors were observed in one case.Besides upper abdominal symptom and physical sign continued in spite of the right lower abdominal discomfort,ascites was discovered by early B-ultrasound.There was no significant increase of serum or urine amylase.After correct diagnosis,all of the 3 cases recovered well by close observation,mental nursing,anti-hyperlipidemic nursing,drainage nursing and health education.Conclusions The knowledge of hyperlipidemic pancreatitis should be well understood during nursing practice.Comprehensive nursing evaluation and close observation can help doctors to analyze and estimate the disease.Integrated nursing techniques can accelerate the recovery of the patients.Health education,anti-hyperlipidemic therapy,and removal of the inducing factors are the keys of prevention. Key words: Acute pancreatitis; Hyperlipidemia; Nursing care

A serum metabolomic investigation on lipoprotein lipase-deficient mice with hyperlipidemic pancreatitis using gas chromatography/mass spectrometry

Hypertriglyceridemia (HTG) is often associated with acute pancreatitis. The relationship between these diseases and the role that hypertriglyceridemia plays in acute pancreatitis pathogenesis remains to be elucidated. In the present study, in order to investigate the mechanisms of hyper-lipidemic acute pancreatitis (HLP), we established an animal model using lipoprotein lipase (LPL)-deficient heterozygous mice injected with caerulein. Susceptibility to pancreatitis in LPL-deficient heterozygous mice was compared with that of wild-type mice after intraperitoneal (i.p.) injections of caerulein by determining amylase release and pancreatic pathological scores. Furthermore, serum metabolome was detected through chemical derivatization followed by gas chromatography/mass spectrometry (GC/MS). GC/MS data were analyzed by orthogonal-projection to latent structures-discriminant analysis (OPLS-DA). Caerulein induced increased levels of serum amylase and more severe pancreatic inflammation in LPL-deficient mice compared to wild-type mice. HLP was discriminated more accurately from healthy controls by the metabolites, including valine, leucine and citrate. The metabolites included valine, leucine, citrate, malic acid, proline, tetradecanoic acid (14:0), glutamine and oleic acid (18:1). Changes in energy, fat and amino acid metabolism were also evident. In conclusion, LPL-deficient heterozygous mice with hypertriglyceridemia (HTG) exhibited enhanced susceptibility to acute pancreatitis. GC/MS data revealed differences between healthy and HLP mice. Therefore, this technique is novel and a useful tool for the study of the HLP pathogenetic mechanism.

Clinical features of hyperlipidemic acute pancreatitis: An analysis of 130 cases

Clinical features of hyperlipidemic acute pancreatitis: An analysis of 130 cases

Therapeutic effect of plasma exchange in treatment of hyperlipidemic acute pancreatitis in elderly patients: An analysis of 74 cases

Therapeutic effect of plasma exchange in treatment of hyperlipidemic acute pancreatitis in elderly patients: An analysis of 74 cases

Clinical features of hyperlipidemic acute pancreatitis: An analysis of 130 cases

Clinical features of hyperlipidemic acute pancreatitis: An analysis of 130 cases

Hyperlipidemic Versus Normal-Lipid Acute Necrotic Pancreatitis

Hyperlipidemia is associated with a variety of pancreatic diseases. However, the underlying pathophysiology and molecular mechanisms between hyperlipidemia and acute pancreatitis remain undefined. Gel electrophoresis and mass spectrometry can be used in proteomic analysis to elucidate these mechanisms. A comparative proteomic analysis was conducted to identify proteins that were altered in pancreases of hyperlipidemic acute necrotic pancreatitis rats compared with those of normal-lipid acute necrotic pancreatitis rats. A comparative proteomic approach using a hyperlipidemic rat model was used. Thirty-nine differentially expressed proteins were significantly changed in pancreatic samples from hyperlipidemic acute necrotic pancreatitis rats. Differentially expressed proteins in hyperlipidemic pancreatitis include pancreatic proteolytic enzymes, such as lipase, amylase, carboxypolypeptidase, and α-1-antiproteinase; endoplasmic reticulum stress-related proteins; and calcium influx-related proteins including protein disulfide isomerase, calreticulin, annexin A, glucose-regulated protein 78, heat shock protein 60, and peroxiredoxin. Other proteins associated with DNA replication and damage repair, apoptosis, cell metabolism, circulatory dysfunction, and signal transduction were identified in hyperlipidemic pancreatitis. Hyperlipidemia intensifies acute necrotic pancreatitis through various ways. These enzymes may be putative biomarkers of hyperlipidemic acute necrotic pancreatitis.

Treatment of hyperlipidemic acute pancreatitis by continuous venovenous hemofiltration: an analysis of 24 cases

Treatment of hyperlipidemic acute pancreatitis by continuous venovenous hemofiltration: an analysis of 24 cases