• Endoscopic retrograde cholangiopancreatography
• Minor papillotomy
• Pancreas divisum
• Recurrent acute pancreatitis
• Sphincter of Oddi disorders
• Sphincterotomy

• Humans
• Pancreatitis/etiology
• Pancreatitis/therapy
• Recurrence
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangiopancreatography, Magnetic Resonance
• Endosonography
• Acute Disease
• Sphincterotomy, Endoscopic

• Cost
• Disparities
• Ethnicity
• Hypertriglyceridemia-induced acute pancreatitis
• Plasmapheresis

• abdominal pain
• computerised tomography
• diabetes mellitus

• Humans
• Emergency Service, Hospital
• Abdominal Pain/etiology
• Diabetes Mellitus
• Tomography, X-Ray Computed/methods
• Diabetes Complications

With the improvement of the living standard, hypertriglyceridemia (HTG) has become the second major cause of acute pancreatitis (AP) in China. Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has its own unique characteristics. First, the elevation of blood amylase and lipase levels is not significant. Second, the severity of the disease positively correlates with blood triglyceride (TG) level. The goal of treatment of HTG-AP is to lower blood lipids rapidly. Common lipid-lowering methods include dietary modification, lipid-lowering drugs, low-molecular heparin combined with insulin, blood purification, and combined Chinese and Western medicine. This article reviews the recent advances on lipid-lowering approaches used in HTG-AP patients.

• Hypertriglyceridemia-induced acute pancreatitis
• Triglyceride
• Lipid-lowering therapy

• Acute pancreatitis
• HTD4010
• NF-κB
• Necroptosis
• TLR4

The frequency of acute hypertriglyceridemic pancreatitis (AHTGP) is increasing worldwide. AHTGP may be associated with a more severe clinical course and greater mortality than pancreatitis caused by other causes. Early identification of patients with severe inclination is essential for clinical decision-making and improving prognosis. Therefore, we first developed and validated a risk prediction score for the severity of AHTGP in Chinese patients.

To develop and validate a risk prediction score for the severity of AHTGP in Chinese patients.

We performed a retrospective study including 243 patients with AHTGP. Patients were randomly divided into a development cohort (n = 170) and a validation cohort (n = 73). Least absolute shrinkage and selection operator and logistic regression were used to screen 42 potential predictive variables to construct a risk score for the severity of AHTGP. We evaluated the performance of the nomogram and compared it with existing scoring systems. Last, we used the best cutoff value (88.16) for severe acute pancreatitis (SAP) to determine the risk stratification classification.

Age, the reduction in apolipoprotein A1 and the presence of pleural effusion were independent risk factors for SAP and were used to construct the nomogram (risk prediction score referred to as AAP). The concordance index of the nomogram in the development and validation groups was 0.930 and 0.928, respectively. Calibration plots demonstrate excellent agreement between the predicted and actual probabilities in SAP patients. The area under the curve of the nomogram (0.929) was better than those of the Bedside Index of Severity in AP (BISAP), Ranson, Acute Physiology and Chronic Health Evaluation (APACHE II), modified computed tomography severity index (MCTSI), and early achievable severity index scores (0.852, 0.825, 0.807, 0.831 and 0.807, respectively). In comparison with these scores, the integrated discrimination improvement and decision curve analysis showed improved accuracy in predicting SAP and better net benefits for clinical decisions. Receiver operating characteristic curve analysis was used to determine risk stratification classification for AHTGP by dividing patients into high-risk and low-risk groups according to the best cutoff value (88.16). The high-risk group (> 88.16) was closely related to the appearance of local and systemic complications, Ranson score ≥ 3, BISAP score ≥ 3, MCTSI score ≥ 4, APACHE II score ≥ 8, C-reactive protein level ≥ 190, and length of hospital stay.

The nomogram could help identify AHTGP patients who are likely to develop SAP at an early stage, which is of great value in guiding clinical decisions.

• Nomogram
• Severity
• Acute pancreatitis
• Prediction model

• Acute Disease
• Apolipoprotein A-I
• C-Reactive Protein/metabolism
• China/epidemiology
• Humans
• Pancreatitis/complications
• Pancreatitis/diagnosis
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Risk Factors
• Severity of Illness Index

• Acute pancreatitis
• Animal
• Hypertriglyceridemia
• Model

• the authors with no additional funding being received

• acute pancreatitis
• bioinformatics
• biomarkers
• hypertriglyceridemia-induced pancreatitis

• the National Natural Science Foundation of China
• Guangxi Natural Science Foundation

Analytic morphometric assessment has recently been proposed to be applied to the study of acute pancreatitis (AP). However, the relationship between body composition and the outcomes of hypertriglyceridemic pancreatitis (HTGP) is still unclear. The aim of this study was to evaluate body composition in relation to the length of hospital stay (LOS) and recurrence of HTGP.

Patient characteristics, admission examination data, body composition parameters, LOS, and recurrence within 1 year were collected from the institutional pancreatitis database and follow-up records. Logistic regression analysis was used to identify risk factors for LOS and recurrence of HTGP.

Of the 196 included patients, 158 (80.6%) were men and 53 (27.0%) were sarcopenic. The average LOS was 15.83±10.02 days. The recurrence rate of HTGP was 36.7%. Multivariate analysis with multiple linear regression suggested that subcutaneous adipose tissue (SAT) area (p=0.019) and high-density lipoprotein-cholesterol (HDL-C) (p=0.001) were independently associated with the LOS for HTGP after adjusting for age and sex. The multivariate adjusted hazard ratios for SAT area and HDL-C, with respect to the relationship between body parameters and LOS, were 1.008 (95% confidence interval [CI], 1.001–1.015) and 0.090 (95% CI, 0.022–0.361), respectively. No significant differences were observed between the AP and recurrent AP (RAP) groups in terms of characteristics, admission examination data, and body composition parameters.

SAT area and HDL-C are associated with LOS in patients with HTGP. The body composition of patients at the first symptom onset of HTGP cannot predict recurrence.

• body composition
• hypertriglyceridemic pancreatitis
• length of hospital stay
• recurrent pancreatitis
• subcutaneous adipose tissue

What kind of patients with hypertriglyceridemic acute pancreatitis (HLAP) might benefit from plasmapheresis (PP) remains unknown. The objective of this study is to determine the predict function of total cholesterol (TC) on the Triglyceride (TG)-lowing effect in patients on either non-PP or PP therapy.

Patients were categorized into high total cholesterol (HTC)/low total cholesterol (LTC) groups based on TC level of 12.4 mmol/L. The primary outcome was TG reduction to below 500 mg/dL within 48 h. Linear mixed-effect model and logistic regression analyses were used to assess the association of TC level and TG-lowing efficacy in different therapy groups.

Compared with LTC group, patients with HTC showed more severe imaging manifestations (p < 0.001) and higher APACH II scores (p = 0.036). Deaths occurred only in HTC groups. Significant interaction of time sequence with the 2 TGs-lowing therapy groups on TG level was only found in HTC group (p < 0.001). In patients with elevated TC level, primary outcome occurred in 66.67% of patients in the PP group, and 27.91% in the non-PP group. After adjustment for age, gender, CT grade and APACH II score, the odd ratio remain significant (OR 5.47, 95% confidence interval [CI] 1.84–16.25, p = 0.002). Furthermore, in patients with lower TC level, no significant difference was found in primary outcome between PP group and non-PP group (81.25% versus 62.30%, adjusted OR 2.05; 95% CI 0.45–9.40; p = 0.353).

TC could be a potential biomarker to predict the effects of TG-lowing therapy in patients with HLAP.

• Acute pancreatitis
• Effectiveness
• Hypertriglyceridemia
• Plasmapheresis
• Total cholesterol

The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption, hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP). The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012 and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures, intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length of hospital stay, pseudocyst, fluid collection and systematic inflammatory response syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55–4.65 and 2.22–4.01, respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR = 1.72 and 1.50, 95% CI 1.04–2.84 and 0.96–2.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08–2.30). Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. Furthermore, AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed on determining aetiology on admission.

• acute hypertriglyceridemic pancreatitis
• triglyceride
• severity

• Acute Disease
• Adult
• China
• Female
• Hospitalization/statistics & numerical data
• Humans
• Hypertriglyceridemia/blood
• Hypertriglyceridemia/complications
• Male
• Middle Aged
• Pancreatitis/blood
• Pancreatitis/etiology
• Prognosis
• ROC Curve
• Retrospective Studies
• Severity of Illness Index
• Triglycerides/blood

• Acute pancreatitis
• Cohort
• Etiology
• Hypertriglyceridemia
• Severity

• general surgery
• hypertriglyceridaemia
• pancreas
• pancreatitis

The aim of the current study was to evaluate influence of serum triglyceride levels on the course of acute pancreatitis (AP).

Rats models of hypertriglyceridemic were used in animal experiments. Following induction of acute pancreatitis, amylase, and pancreas histological scores were all compared. In addition, in a clinical study, clinical data were collected from 1681 AP patients admitted from 2003 to 2016 who were divided into 4 groups based on their serum triglyceride (TG) levels. The clinical features among these 4 groups were compared, and a receiver operating characteristic (ROC) curve analysis was also performed on TG values to estimate their relationship with severity.

In animal experiments, the hypertriglyceridemic pancreatitis (HTGP) group had markedly higher serum amylase, and histological scores relative to the other animal groups. In the clinical study, we identified significant differences in gender, age, body mass index (BMI), cost, and incidence of partial complications among the 4 TG-based groups. Importantly, the TG levels on day 3–4 after admission could be used to accurately predict disease severity.

Hypertriglyceridemia (HTG) can aggravate pancreatic injury, and hypertriglyceridemia patients are more likely to suffer from severe pancreatic injury with a higher possibility of complications. In addition, triglyceride levels are correlated with the severity of AP positively.

• Acute pancreatitis
• Animal model
• Hypertriglyceridemia
• Severity

• Acute pancreatitis
• Hyperlipidaemia
• Hypertriglyceridaemia
• Insulin
• Management
• Plasmapheresis

• Acute Disease
• Adult
• Body Mass Index
• Female
• Genetic Therapy
• Humans
• Hyperlipidemias/complications
• Hyperlipidemias/physiopathology
• Hyperlipidemias/therapy
• Hypertriglyceridemia/complications
• MEDLINE
• Male
• Middle Aged
• Pancreatitis/epidemiology
• Pancreatitis/physiopathology
• Pancreatitis/therapy
• Plasmapheresis
• Pregnancy
• Pregnancy Complications
• Recurrence
• Triglycerides/blood

• MR/P021220/1 Medical Research Council
• Department of Health

• Humans
• Hypertriglyceridemia/blood
• Pancreatitis/blood
• Pancreatitis/diagnosis
• Prognosis
• Triglycerides/blood

• EFOP-3.6.2-16-2017-00006 GINOP-2.3.2-15-2016-00048 NKFIH K 119938

• Acute kidney injury(AKI)
• Biliary acute pancreatitis
• Body Mass Index(BMI)
• Hypertriglyceridemia acute pancreatitis
• Infected pancreatic necrosis

Hypertriglyceridemia is the third most common cause of acute pancreatitis, but whether the level of triglyceride (TG) is related to severity of pancreatitis is unclear.

To evaluate the effect of TG level on the severity of hypertriglyceridemic pancreatitis (HTGP).

Retrospective cohort study.

We reviewed the records of 144 patients with HTGP from 1999 to 2013 at Tri-Service General Hospital. Patients with possible etiology of pancreatitis, such as gallstones, those consuming alcohol or drugs, or those with infections were excluded. The classification of severity of pancreatitis was based on the revised Atlanta classification. We allocated the patients into high-TG and low-TG groups based on the optimal cut-off value (2648 mg/dL), which was derived from the receiver operating characteristic (ROC) curve between TG level and severity of HTGP. We then compared the clinical characteristics, pancreatitis severity, and mortality rates of the groups.

There were 66 patients in the low-TG group and 78 patients in the high-TG group. There was no significant difference in the age, sex ratio, body mass index, and comorbidity between the 2 groups. The high-TG group had significantly higher levels of glucose (P = 0.022), total cholesterol (P = 0.002), and blood urea nitrogen (P = 0.037), and lower levels of sodium (P = 0.003) and bicarbonate (P = 0.002) than the low-TG group. The incidences of local complication (P = 0.002) and severe and moderate form of pancreatitis (P = 0.004) were significantly higher in the high-TG group than in the low-TG group. The mortality rate was higher in the high-TG group than in the low-TG group (P = 0.07).

Higher TG level in patients with HTGP may be associated with adverse prognosis, but randomized and prospective studies are needed in the future verify this relationship.

• Adult
• Area Under Curve
• Bicarbonates/blood
• Blood Glucose/analysis
• Blood Urea Nitrogen
• Cholesterol/blood
• Female
• Hospitals, General
• Humans
• Hypertriglyceridemia/complications
• Male
• Middle Aged
• Pancreatitis/etiology
• Pancreatitis/mortality
• Pancreatitis/pathology
• ROC Curve
• Retrospective Studies
• Severity of Illness Index
• Sodium/blood
• Survival Rate
• Triglycerides/blood