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Huang YE, Yang CY. Successful management of a pregnancy women with sudden onset of acute pancreatitis: A case report and literature review. Taiwan J Obstet Gynecol 2025; 64:368-371. [PMID: 40049829 DOI: 10.1016/j.tjog.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2025] [Indexed: 05/13/2025] Open
Abstract
OBJECTIVE Hypertriglyceridemia (HTG) is a rare cause of acute pancreatitis (AP) in pregnancies and has emerged as an aggravating factor of severe pancreatitis. To enhance the diagnosis and management of HTG-induced AP during pregnancy by improving early recognition, optimizing treatment strategies, and minimizing maternal and fetal complications. CASE REPORT This is a 29-year-old multigravida woman at a gestational age of 34 weeks and 2 days who presented with sudden abdominal pain and vomiting. She had severe hypertriglyceridemia (7855 mg/dL) and was diagnosed with acute pancreatitis. After an emergency cesarean section, the patient received aggressive hydration, as well as fenofibrate and gemfibrozil as lipid-lowering agents, along with other supportive care. This treatment led to a successful recovery. CONCLUSION The management of HTG-induced AP must consider both maternal and fetal health, with options such as lipid-lowering agents and plasmapheresis being explored, further research was required to ascertain their safety during pregnancy.
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Affiliation(s)
- Yi-Er Huang
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Yi Yang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
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2
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Haiyan Z, Na P, Yong G, Xiumei B, Jianying B. Impact of acute pancreatitis during pregnancy in Chinese women: a meta-analysis. J OBSTET GYNAECOL 2022; 42:2879-2887. [PMID: 35993525 DOI: 10.1080/01443615.2022.2110462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A random-effects meta-analysis was performed in English and Chinese databases since its inception to August 2020 to assess the incidence, causes and severity of acute pancreatitis (AP) at various stages of pregnancy, maternal and foetal mortality. A total of 154 articles representing 4034 patients with AP during pregnancy in China were included for the analysis. The incidence of AP during pregnancy was 0.0469 (95% confidence interval [CI], 0.0349; 0.0627) in the first trimester, whereas it was 0.2518 (95% CI, 0.2210; 0.2854) and 0.6323 (95% CI, 0.5870; 0.6753) in the second and third trimester, respectively. The major causes of AP were hypertriglyceridaemia (0.351 [95% CI, 0.3202; 0.3834]) and biliary pancreatitis (0.424 [95% CI, 0.4094; 0.5002]). The severity of AP was mild in majority of the patients. The incidence of AP at maternal mortality was 0.0184 (95% CI, 0.0126; 0.0269) and foetal mortality was 0.1018 (95% CI, 0.0867; 0.1192). Our meta-analysis revealed that hypertriglyceridaemia and biliary pancreatitis remain the major causes of AP during pregnancy. Foetal mortality requires further investigation. IMPACT STATEMENTWhat is already known on this subject? Acute pancreatitis (AP) in pregnant women is characterised by acute onset and delay in understanding the interaction of the metabolic changes with pancreatic pathophysiology, and thus becomes difficult to diagnose the disease and provide timely treatment to the patients. This poses a greater health risk among women and their foetus by increasing their chances of mortality.What the results of this study add? We performed an exhaustive, random-effects meta-analysis involving 154 articles representing 4034 patients to assess the incidence of AP at various stages of pregnancy, the causes of AP and the severity of AP during pregnancy, maternal and foetal mortality.What are the implications of these findings for clinical practice and/or further research? Our meta-analysis revealed that hypertriglyceridaemia and biliary pancreatitis remain the major causes of AP during pregnancy. Although the rates of maternal mortality have decreased in the recent years, foetal mortality still remains high and requires further investigation.
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Affiliation(s)
- Zhao Haiyan
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Peng Na
- Department of Obstetrics and Gynecology, Affiliated Hospital of Chongqing Institute of Population and Family Planning Science and Technology, Chongqing, China
| | - Gao Yong
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Bai Xiumei
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Bai Jianying
- Department of Gastroenterology, Second Affiliated Hospital of Army Medical University, Chongqing, China
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3
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Kumar-M P, Singh AK, Samanta J, Birda CL, Kumar N, Dhar J, Gupta P, Kochhar R. Acute pancreatitis in pregnancy and its impact on the maternal and foetal outcomes: A systematic review. Pancreatology 2022; 22:210-218. [PMID: 34961727 DOI: 10.1016/j.pan.2021.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/13/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of AP in pregnancy (APIP) is uncertain with varying reports of its impact on maternal and foetal outcomes. OBJECTIVES This study was aimed to find the prevalence of APIP and its effect on the maternal and foetal outcomes. SEARCH STRATEGY Electronic databases were searched upto 31.05.2020 for the appropriate studies. SELECTION CRITERIA Prospective, retrospective observational studies or case series evaluating APIP in terms of maternal and foetal outcomes were included. DATA COLLECTION AND ANALYSIS Data on the prevalence of APIP, etiology, maternal mortality rates and foetal outcomes were collated. Due to high heterogeneity among the studies, the data has been represented as a systematic review. RESULTS A total of 16 studies with 8466 pregnant patients were included in the systematic review. The overall prevalence of APIP ranged from 0.225/1000 pregnancies to 2.237/1000 pregnancies. Gallstone disease was the most common cause ranging from 14.29 to 96.3%, with eastern studies reporting more cases of hypertriglyceridemia as etiology. Mild pancreatitis was noted in 33.33-100% of cases with milder disease among western studies. APIP incidence was higher during 3rd trimester (27.27%-95.24%). Maternal mortality ranged from 0 to 12.12/100 pregnancies. Foetal loss ranged from 0 to 23.08%, with adverse foetal outcomes ranging from 0 to 57.41%. Neonatal mortality ranged from 0 to 75.5/1000 neonatal live birth. CONCLUSION APIP is usually mild, but its incidence increases with gestational age. Maternal outcome is usually good but adverse foetal outcome is high in APIP (PROSPERO No.: CRD42020194313).
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Affiliation(s)
| | | | | | | | - Naveen Kumar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Jahnvi Dhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Comparison of the Development and Prognosis in Patients of Hypertriglyceridemic Pancreatitis with and without Diabetes. Gastroenterol Res Pract 2021; 2021:8895268. [PMID: 34925505 PMCID: PMC8677390 DOI: 10.1155/2021/8895268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/22/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022] Open
Abstract
Aim To investigate the clinical features and prognosis in patients of hyperlipidemic acute pancreatitis with or without diabetes. Methods 157 patients with hypertriglyceridemic pancreatitis (HTGP) were included in this study. Patients with a previous history of diabetes were identified in the group of HTGP with diabetes (HTGPD), while patients without a history of diabetes were identified in the group of HTGP. The clinical characteristics and prognosis data of these patients in the two groups were analyzed. Results Multivariate Cox regression analysis showed that age, body mass index, glycated serum protein (GSP), and Acute Physiology and Chronic Health Evaluation (APACHE) II score were significantly associated with mortality in patients with HTGP. The mortality was significantly higher in the HTGPD group than in the HTGP group (p < 0.001). Compared to patients of HTGP, those of HTGPD had older age of onset, higher blood glucose levels, and higher GSP levels on admission. Electrocardiograms showed that patients of HTGPD had a significantly higher risk of heart ischemia than those of HTGP (p < 0.05). Patients of HTGPD had higher APACHE II scores than those of HTGP (p < 0.001). Single-factor analysis showed that higher triglyceride levels, GSP, LDL, and previous history of diabetes were associated with HTGP recurrence. Conclusions Clinicians should be alert to patients of HTGP with diabetes. Diabetes is an important risk factor for HTGP and hyperglycemia may affect the development and prognosis of HTGP.
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Ali AS. Insulin can be used to treat severe hypertriglyceridaemia in pregnant women without diabetes. BMJ Case Rep 2021; 14:14/7/e243508. [PMID: 34290025 DOI: 10.1136/bcr-2021-243508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Severe hypertriglyceridaemia can lead to acute pancreatitis, which is associated with maternal and perinatal mortality when it occurs in pregnancy. Rapid reduction of triglyceride levels is a primary goal in the management of severe hypertriglyceridaemia, however, there are limited safe option for treatment in pregnancy. We present a case of a woman without diabetes presenting with severe hypertriglyceridaemia in late gestation who was safely and successfully treated with insulin and review the literature surrounding the management of this important condition.
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Affiliation(s)
- Aleena Shujaat Ali
- Endocrinology, Barwon Health, Geelong, Victoria, Australia .,Obstetric Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Endocinology, Austin Health, Melbourne, Victoria, Australia
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6
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Okazaki H, Gotoda T, Ogura M, Ishibashi S, Inagaki K, Daida H, Hayashi T, Hori M, Masuda D, Matsuki K, Yokoyama S, Harada-Shiba M. Current Diagnosis and Management of Primary Chylomicronemia. J Atheroscler Thromb 2021; 28:883-904. [PMID: 33980761 PMCID: PMC8532063 DOI: 10.5551/jat.rv17054] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary chylomicronemia (PCM) is a rare and intractable disease characterized by marked accumulation of chylomicrons in plasma. The levels of plasma triglycerides (TGs) typically range from 1,000 - 15,000 mg/dL or higher.
PCM is caused by defects in the lipoprotein lipase (LPL) pathway due to genetic mutations, autoantibodies, or unidentified causes. The monogenic type is typically inherited as an autosomal recessive trait with loss-of-function mutations in LPL pathway genes (
LPL
,
LMF1
,
GPIHBP1
,
APOC2
, and
APOA5
). Secondary/environmental factors (diabetes, alcohol intake, pregnancy, etc.) often exacerbate hypertriglyceridemia (HTG).
The signs, symptoms, and complications of chylomicronemia include eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, and acute pancreatitis with onset as early as in infancy. Acute pancreatitis can be fatal and recurrent episodes of abdominal pain may lead to dietary fat intolerance and failure to thrive. The main goal of treatment is to prevent acute pancreatitis by reducing plasma TG levels to at least less than 500-1,000 mg/dL. However, current TG-lowering medications are generally ineffective for PCM. The only other treatment options are modulation of secondary/environmental factors. Most patients need strict dietary fat restriction, which is often difficult to maintain and likely affects their quality of life. Timely diagnosis is critical for the best prognosis with currently available management, but PCM is often misdiagnosed and undertreated. The aim of this review is firstly to summarize the pathogenesis, signs, symptoms, diagnosis, and management of PCM, and secondly to propose simple diagnostic criteria that can be readily translated into general clinical practice to improve the diagnostic rate of PCM. In fact, these criteria are currently used to define eligibility to receive social support from the Japanese government for PCM as a rare and intractable disease. Nevertheless, further research to unravel the molecular pathogenesis and develop effective therapeutic modalities is warranted. Nationwide registry research on PCM is currently ongoing in Japan with the aim of better understanding the disease burden as well as the unmet needs of this life-threatening disease with poor therapeutic options.
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Affiliation(s)
- Hiroaki Okazaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo
| | - Takanari Gotoda
- Department of Metabolic Biochemistry, Faculty of Medicine, Kyorin University
| | - Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Jichi Medical University
| | - Kyoko Inagaki
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Nippon Medical School
| | - Hiroyuki Daida
- Faculty of Health Science, Juntendo University, Juntendo University Graduate School of Medicine
| | - Toshio Hayashi
- School of Health Sciences, Nagoya University Graduate School of Medicine
| | - Mika Hori
- Department of Endocrinology, Research Institute of Environmental Medicine, Nagoya University
| | - Daisaku Masuda
- Department of Cardiology, Health Care Center, Rinku Innovation Center for Wellness Care and Activities (RICWA), Rinku General Medical Center
| | - Kota Matsuki
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine
| | | | - Mariko Harada-Shiba
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
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7
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Nguyen NT, Nath PV, Mai VQ, Shakir MKM, Hoang TD. Treatment of Severe Hypertriglyceridemia During Pregnancy With High Doses of Omega-3 Fatty Acid and Plasmapheresis. AACE Clin Case Rep 2021; 7:211-215. [PMID: 34095491 PMCID: PMC8165119 DOI: 10.1016/j.aace.2021.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 01/23/2023] Open
Abstract
Objective Severe hypertriglyceridemia carries increased health risks, including the development of pancreatitis. The objective of this study was to report on management of 2 cases with severe gestational hypertriglyceridemia. Cases In case 1, a 33-year-old pregnant woman presented with serum triglyceride level of 14 000 mg/dL after discontinuing hypolipidemic medications. She was treated with Lovaza 12 g/day, and serum triglyceride remained near normal at level of less than 800 mg mg/dL until delivery. In case 2, a 28-year-old patient (29th week gestation) presented with acute pancreatitis and triglycerides >4000 mg/dL. She was treated with Gemfibrozil, Lovaza, insulin infusion, subcutaneous heparin, and escalated to plasmapheresis. She successfully delivered a baby at the week of 36th and her triglyceride level was 304 mg/dL after that. Discussion Case 1 was treated with high-dose Lovaza and case 2 was treated with plasmapheresis successfully. Triglyceride levels were reduced to less than 500 mg/dL until delivery of healthy babies in both cases. Conclusion Omega-3 fatty acids and plasmapheresis may be effective and safe to treat pregnant women with severe hypertriglyceridemia and pancreatitis.
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Affiliation(s)
- Nguyen T Nguyen
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Priti V Nath
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Vinh Q Mai
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mohamed K M Shakir
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Thanh D Hoang
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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8
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Zeng L, Cai X, Chen J, Jin G, Zheng Y. Role of mean platelet volume in hypertriglyceridemia-induced acute pancreatitis during pregnancy. BMC Pregnancy Childbirth 2020; 20:592. [PMID: 33023512 PMCID: PMC7539523 DOI: 10.1186/s12884-020-03295-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hypertriglyceridemia-induced acute pancreatitis during pregnancy (HTG-APP) is a rare but severe disease with high maternal-fetal mortality risk, which constitutes a systemic inflammatory process accompanied by thrombosis and bleeding disorders. However, the role of mean platelet volume (MPV) in HTG-APP remains unclear. METHODS In the retrospective study, we collected 45 patients with HTG-APP as the HTG-APP group and 49 pregnant females with hypertriglyceridemia as the control group. MPV and other relevant variables at onset and remission were collected and compared. RESULTS MPV were significantly higher in the HTG-APP group than in the control group (P < 0.001), and lower in remission than on onset (P = 0.002). According to the severity of acute pancreatitis, all subjects were classified into mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP) groups. There was a significant difference in MPV on onset among the three groups (P = 0.048), and the SAP patients had the highest levels of MPV. In addition, only in the SAP group, MPV was lower in remission than on onset (P = 0.010). Logistic regression analyses revealed that MPV was significantly associated with SAP (odds ratio = 2.077, 95% confdence interval, 1.038-4.154; P = 0.039). CONCLUSIONS These results may indicate an important role of mean platelet volume in evaluating the severity of HTG-APP.
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Affiliation(s)
- Longhuan Zeng
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, 310006, Hangzhou, Zhejiang, China
| | - Xueying Cai
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, 310006, Hangzhou, Zhejiang, China
| | - Jiayi Chen
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, 310006, Hangzhou, Zhejiang, China
| | - Guangyong Jin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, 310006, Hangzhou, Zhejiang, China
| | - Yongke Zheng
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, 310006, Hangzhou, Zhejiang, China.
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9
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Ong M, Jerreat L, Hameed A. Familial hypertriglyceridaemia and type 2 diabetes in pregnancy: prevention of acute pancreatitis with diet control and omega-3 fatty acids. BMJ Case Rep 2019; 12:12/5/e227321. [PMID: 31110063 DOI: 10.1136/bcr-2018-227321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute pancreatitis in pregnancy is rare and can be caused by hypertriglyceridaemia. The management of hypertriglyceridaemia in pregnancy is complex and challenging as many lipid-lowering medications have been found to be unsafe in pregnancy. Patients who present with hypertriglyceridaemia commonly have multiple risk factors such as, diabetes, alcohol excess and hypothyroidism which pose a greater challenge to the management of these patients. We present a case of a 31-year-old woman presenting with familial hypertriglyceridaemia and type 2 diabetes mellitus in her third pregnancy. She had an uneventful pregnancy with the use of omega-3 fatty acids nutritional support, low-fat diet and tight glucose control with insulin and metformin.
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Affiliation(s)
- Melissa Ong
- Faculty of Life Sciences and Medicine, King's College London School of Medical Education, London, UK
| | - Lynne Jerreat
- Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Orpington, UK
| | - Aisha Hameed
- Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Orpington, UK
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10
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Effect of Two Supplements on Gestational Hypertriglyceridemia: Report of Two Cases. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.5812/whb.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Lei JJ, Zhou L, Liu Q, Xiong C, Xu CF. Can mean platelet volume play a role in evaluating the severity of acute pancreatitis? World J Gastroenterol 2017; 23:2404-2413. [PMID: 28428720 PMCID: PMC5385407 DOI: 10.3748/wjg.v23.i13.2404] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/28/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate serum mean platelet volume (MPV) levels in acute pancreatitis (AP) patients and assess whether MPV effectively predicts the disease severity of AP. METHODS We included 117 consecutive patients with AP as the AP group and 34 consecutive patients with colorectal polyps (before endoscopic treatment) as the control group. Complete blood counts, liver function, platelet indices (MPV), coagulation parameters, lactate dehydrogenase (LDH) and C-reactive protein (CRP) were measured on days 1, 2, 3 and 7 after admission. Receiver operating characteristic curves were used to compare the sensitivity and specificity of MPV, white blood cell (WBC), LDH and CRP in predicting AP severity. The Modified Glasgow Prognostic Score (mGPS) and the 2012 revised Atlanta criteria were used to evaluate disease severity in AP. RESULTS MPV levels were significantly lower in the AP group than in the control group on day 1 (P = 0.000), day 2 (P = 0.029) and day 3 (P = 0.001) after admission. In addition, MPV values were lower on day 1 after admission than on day 2 (P = 0.012), day 3 (P = 0.000) and day 7 (P = 0.002) in all AP patients. Based on the mGPS, 78 patients (66.7%) were diagnosed with mild and 39 patients (33.3%) with severe AP. There was no significant difference in mean MPV levels between patients diagnosed with mild and severe AP based on the mGPS (P = 0.424). According to the 2012 revised Atlanta criteria, there were 98 patients (83.8%) without persistent organ failure (OF) [non-severe acute pancreatitis (non-SAP) group] and 19 patients (16.2%) with persistent OF (SAP group). MPV levels were significantly lower in the SAP group than in the non-SAP group on day 1 after admission (P = 0.002). On day 1 after admission using a cut-off value of 6.65 fL, the overall accuracy of MPV for predicting SAP according to the 2012 revised Atlanta criteria (AUC = 0.716) had a sensitivity of 91.8% and a specificity of 47.4% and was superior to the accuracy of the traditional markers WBC (AUC = 0.700) and LDH (AUC = 0.697). CONCLUSION MPV can be used at no additional cost as a useful, non-invasive biomarker that distinguishes AP with persistent OF from AP without persistent OF on day 1 of hospital admission.
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12
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Huang J, Qu HP, Zheng YF, Song XW, Li L, Xu ZW, Mao EQ, Chen EZ. The revised Atlanta criteria 2012 altered the classification, severity assessment and management of acute pancreatitis. Hepatobiliary Pancreat Dis Int 2016; 15:310-315. [PMID: 27298108 DOI: 10.1016/s1499-3872(15)60040-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classification of AP, the severity assessment and management. METHODS The clinical features, severity classification, outcome and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS Compared to the OAC group, the incidence of severe acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC presented a lower sensitivity but higher specificity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was significantly lower than that in the OAC group (P<0.05). Based on the RAC, the risk factors for death among SAP patients were older age, high CT severity index (CTSI), renal failure, cardiovascular failure, acute necrotic collection and walled-off necrosis. Compared to the OAC, the acute physiology and chronic health evaluation II (APACHE II) score, Ranson score, idiopathic etiology, respiratory failure and laparotomy debridement were not risk factors of death in contrast to walled-off necrosis. Interestingly, hypertriglyceridemia-related SAP had good outcomes in both groups. CONCLUSIONS The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, complications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.
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Affiliation(s)
- Jie Huang
- Department of Surgery and Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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13
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Xu Q, Wang S, Zhang Z. A 23-year, single-center, retrospective analysis of 36 cases of acute pancreatitis in pregnancy. Int J Gynaecol Obstet 2015; 130:123-6. [PMID: 25983209 DOI: 10.1016/j.ijgo.2015.02.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/09/2015] [Accepted: 04/22/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the incidence, causes, clinical characteristics, and outcomes of cases of acute pancreatitis in pregnancy (APIP). METHODS A retrospective review was conducted of the medical records of pregnant women who were diagnosed with APIP at any point during pregnancy, labor, or the puerperium and attended Beijing Chaoyang Hospital, China, between January 1, 1991, and March 31, 2014. RESULTS Among 34 292 pregnant women admitted to the center during the study period, 36 patients were diagnosed with APIP. The condition developed during the second (9 [25%] cases) and third (22 [61%]) trimesters. The underlying cause was hypertriglyceridemia for 14 (39%) patients and biliary diseases for 7 (19%). Severe acute pancreatitis was significantly more common among patients with hypertriglyceridemia (11/14 [79%]) than among those without hypertriglyceridemia (6/22 [27%]; P=0.006). Additionally, complications were recorded for more patients with hypertriglyceridemia (11 [79%]) than those without hypertriglyceridemia (4 [18%]; P<0.001). Delayed diagnosis was more common among patients with severe acute pancreatitis (8/17 [47%]) than among those with mild acute pancreatitis (3/19 [16%]; P=0.039). No maternal deaths and only two perinatal deaths were recorded. CONCLUSION The overall incidence of APIP was low; however, hypertriglyceridemia was associated with poor outcomes. Early diagnosis and prompt treatment should be implemented to improve maternal and fetal prognosis and decrease mortality.
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Affiliation(s)
- Qiuxiang Xu
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sumei Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Nakao J, Ohba T, Takaishi K, Katabuchi H. Omega-3 fatty acids for the treatment of hypertriglyceridemia during the second trimester. Nutrition 2015; 31:409-12. [DOI: 10.1016/j.nut.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022]
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15
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Severe hypertriglyceridemia induced pancreatitis in pregnancy. Case Rep Obstet Gynecol 2014; 2014:485493. [PMID: 24995138 PMCID: PMC4065762 DOI: 10.1155/2014/485493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/01/2014] [Accepted: 05/23/2014] [Indexed: 11/23/2022] Open
Abstract
Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis.
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Thulasidass K, Chowdhury TA. Hypertriglyceridemic pancreatitis in pregnancy: case reports and review of the literature. JRSM SHORT REPORTS 2013; 4:2042533313481211. [PMID: 24040494 PMCID: PMC3767063 DOI: 10.1177/2042533313481211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kumar Thulasidass
- Department of Diabetes and Metabolism, The Royal London Hospital, Whitechapel, London E1 1BB, UK
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17
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Clinical study on acute pancreatitis in pregnancy in 26 cases. Gastroenterol Res Pract 2012; 2012:271925. [PMID: 23213326 PMCID: PMC3506915 DOI: 10.1155/2012/271925] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/22/2012] [Accepted: 10/22/2012] [Indexed: 12/14/2022] Open
Abstract
Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients' requirements. (2) Four cases of all patients were complicated with severe acute pancreatitis (SAP); 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.
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Abstract
Aim. This paper investigated the pathogenesis and treatment strategies of acute pancreatitis (AP) in pregnancy. Methods. We analyzed retrospectively the characteristics, auxiliary diagnosis, treatment strategies, and clinical outcomes of 26 cases of patients with AP in pregnancy. Results. All patients were cured finally. (1) Nine cases of 22 mild acute pancreatitis (MAP) patients selected automatic termination of pregnancy because of the unsatisfied therapeutic efficacy or those patients' requirements. (2) Four cases of all patients were complicated with severe acute pancreatitis (SAP); 2 cases underwent uterine incision delivery while one of them also received cholecystectomy, debridement and drainage of pancreatic necrosis, and percutaneous jejunostomy. One case had a fetal death when complicated with SAP; she had to receive extraction of bile duct stones and drainage of abdominal cavity after induced abortion. The other one case with hyperlipidemic pancreatitis was given induced abortion and hemofiltration. Conclusions. The first choice of MAP in pregnancy is the conventional therapy. Apart from the conventional therapy, we need to terminate pregnancy as early as possible for patients with SAP. Removing biliary calculi and drainage is supposed to be considered for acute biliary pancreatitis. Lowering blood lipids treatment should be applied to hyperlipidemic pancreatitis or given to hemofiltration when necessary.
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Chen YH, Chen K, Yang YS, Xie WR, Du ZW, Wang H. Advances in understanding the role of gene mutations in the pathogenesis of hyperlipidemic acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2012; 20:2364-2369. [DOI: 10.11569/wcjd.v20.i25.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a common disorder that manifests as acute abdomen and has an extremely high mortality rate. At present, the pathogenesis of AP has become a hot topic of research but has not been completely clarified yet. The relationship between hyperlipidemia (HL) and AP has attracted wide attention. Gene mutations, especially mutations in the lipoprotein lipase (LPL), glycosylphosphatidylinositol anchored high density lipoprotein-binding protein 1 (GPIHBP1) and apolipoprotein A-V (apoA-V) genes, are closely associated with the pathogenesis of HL and recurrent pancreatitis. In this article, we will review the recent progress in understanding the role of gene mutations in the pathogenesis of hyperlipidemic AP (HLAP).
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Affiliation(s)
- P S Parulekar
- University of Oxford, Headington, Oxford OX3 9DU, UK
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21
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Thomson A, Subramaniam K, Davies A. Nutritional therapy in acute pancreatitis--time to take stock. Nutrition 2012; 28:731-2. [PMID: 22516372 DOI: 10.1016/j.nut.2011.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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Papadakis EP, Sarigianni M, Mikhailidis DP, Mamopoulos A, Karagiannis V. Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol 2011; 159:261-6. [PMID: 21840110 DOI: 10.1016/j.ejogrb.2011.07.037] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 07/10/2011] [Accepted: 07/14/2011] [Indexed: 12/16/2022]
Abstract
Acute pancreatitis is rare in pregnancy but it is associated with increased incidence of maternal and fetal mortality. It should be considered in the differential diagnosis of upper quadrant abdominal pain with or without nausea and vomiting. The commonest identified causes of acute pancreatitis in pregnancy are gallstones, alcohol and hypertriglyceridemia. The main laboratory finding is increased amylase activity. Appropriate investigations include ultrasound of the right upper quadrant and measurement of serum triglycerides and ionized calcium. Management of gallstone pancreatitis is controversial, although laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) are often used and may be associated with lower complication rates. In hypertriglyceridemia-induced acute pancreatitis ω-3 fatty acids and even therapeutic plasma exchange can be used. We also discuss preventive measures.
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Affiliation(s)
- Efstathios P Papadakis
- 3rd Department of Obstetrics and Gynecology, Hippokration General Hospital, Aristotle University Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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23
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Sena JIND, Guimarães SB, Vasconcelos PRLD. Metabolic changes induced by pre-administration of L-alanyl-glutamine and omega-3 in Wistar rats subjected to sepsis. Acta Cir Bras 2011; 25:529-34. [PMID: 21120286 DOI: 10.1590/s0102-86502010000600013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/21/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the metabolic changes induced by pre-administration of L-alanyl-glutamine (L-Ala-Gln) and omega-3 (ω-3) in rats subjected to sepsis. METHODS Eighteen male Wistar rats were randomized into three groups (n=6) and treated with saline (group Control-G-1), L-Ala-Gln (0.75 mg /kg , G-2) or ω-3 (0.2 g /kg, G-3 ) administered intravenously 3, 2 and 1 day and 30 minutes before induction of sepsis. Samples (blood, striated muscle and liver) were collected 48 hours after induction of sepsis, to measure the concentrations of metabolites (pyruvate, lactate, glucose and ketone bodies. RESULTS There was a significant increase in muscle glycolysis and gluconeogenesis in the liver in rats treated with L-Ala-Gln and ω-3, compared to the control group, 48 hours after induction of sepsis. CONCLUSION Pre-administration of L-Ala-Gln or ω-3 to rats subjected to sepsis resulted in similar metabolic changes, by rising glycolysis in peripheral tissues and stimulating hepatic gluconeogenesis and ketogenesis, resulting in increased energy supply to septic rats.
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Abel T, Blázovics A, Kemény M, Lengyel G. [Hyperlipoproteinemia in pregnancy]. Orv Hetil 2011; 152:753-7. [PMID: 21498165 DOI: 10.1556/oh.2011.29108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Physiological changes in lipoprotein levels occur in normal pregnancy. Women with hyperlipoproteinemia are advised to discontinue statins, fibrates already when they consider pregnancy up to and including breast-feeding the newborn, because of the fear for teratogenic effects. Hypertriglyceridemia in pregnancy can rarely lead to acute pancreatitis. Management of acute pancreatitis in pregnant women is similar to that used in non-pregnant patients. Further large cohort studies are needed to estimate the consequence of supraphysiologic hyperlipoproteinemia or extreme hyperlipoproteinemia in pregnancy on the risk for cardiovascular disease later in life.
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Affiliation(s)
- Tatjána Abel
- Állami Egészségügyi Központ Szakrendelő Intézet Budapest Róbert Károly krt. 44. 1134.
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Abstract
OBJECTIVE The highest maternal-fetal risk from pancreatitis in pregnancy is likely to be posed by the most severe cases, which we have compared with mild cases. DESIGN Retrospective observational study. SETTING A general surgery department of a university referral hospital in Nanjing, China. POPULATION Eighteen pregnancies complicated with severe acute pancreatitis and 51 pregnancies complicated with mild acute pancreatitis. METHODS Medical records were reviewed for every pregnant woman with mild or severe acute pancreatitis during January 1999 to December 2009. MAIN OUTCOME MEASURES Information on demographics, clinical and laboratory data, maternal and fetal outcomes. RESULTS Gestational age of onset was significantly higher in the severe acute pancreatitis group than in the mild acute pancreatitis group. Severe hypertriglyceridemia was considered the main cause of severe acute pancreatitis (OR 20.7; 95% CI 4.6-92.4, p<0.001), while biliary disease contributed to the etiology of mild acute pancreatitis (OR 7.3; 95% CI 1.8-30.1, p<0.01). Abortions and preterm infants contributed to fetal loss in the mild group, while fetal death and stillbirth contributed in the severe group. CONCLUSIONS Hyperlipidemic pancreatitis and biliary pancreatitis are the main causes of severe and mild disease, respectively. Severe acute pancreatitis in pregnancy usually occurs in the third trimester, and the affected severe patients are more liable to develop a critical condition that results in higher risk of intrauterine fetal death.
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Affiliation(s)
- Liqun Sun
- Medical School of Nanjing University, Department of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, China.
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Abstract
Management of acute pancreatitis in pregnancy is based on expert opinion only, due to geographic and ethic variations. Nonbiliary causes should be sought as they are associated with worse outcomes. Alcohol as a cause of acute pancreatitis is not rare. Hemoconcentration as a marker of fluid deficit and severity should be predicted with caution and fluid resuscitation should be done carefully by closely monitoring the central venous pressure, cardiac and respiratory system. Hypercalcemia of hyperparathyroidism may be falsely lowered due to hypoalbuminemia or suppressed by magnesium tocolysis.
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Severe hypertriglyceridemia complicating pregnancy, management by dietary intervention and ω-3 fatty acid supplementation. Nutrition 2009; 25:1098-9. [DOI: 10.1016/j.nut.2009.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/06/2009] [Indexed: 11/17/2022]
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