Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study

doi:10.3748/wjg.v28.i29.3946

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World Journal of Gastroenterology

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Retrospective Study

World J Gastroenterol. Aug 7, 2022; 28(29): 3946-3959
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.3946

Table 1 Clinical characteristics of hypertriglyceridemic acute pancreatitis

Characteristic	All (n = 371)
Sex, n (%)
Male	247 (66.6)
Female	124 (33.4)
Age, yr	39.86 ± 10.20
BMI (kg/m²)	25.99 ± 3.18
Causes, n (%)	203 (54.7)
Diet (high fatty acid)	127 (34.2)
Drinking (beer)	55 (14.8)
Mixed	21 (5.7)
Complications, n (%)
Diabetes mellitus	115 (31.0)
Hypertension	62 (16.7)
Fatty liver disease	336 (90.6)
Pregnancy	11 (3.0)
Recurrence, n (%)	122 (32.9)
Grades of severity, n (%)
MAP	63 (17.0)
MSAP	208 (56.1)
SAP	100 (26.9)
Improved Marshall score	1.30 ± 1.77
Organ failure, n (%)	117 (31.5)
MCTSI score	5.00 ± 1.83
Lipid-lowering treatment, n (%)
Intravenous insulin	144 (38.8)
HP	32 (8.6)
CRRT/HP + CRRT	77 (20.8)
Only anti-lipemic	118 (31.8)
Baseline TG, mg/dL	2544.59 ± 2305.37
Baseline AMY (nUNL)	5.00 ± 6.47
> UNL, n (%)	297 (80.1)
≥ 3UNL, n (%)	174 (46.9)
Admission to ICU, n (%)	126 (34.0)
Death, n (%)	11 (3.0)

BMI: Body mass index; MAP: Mild acute pancreatitis; MSAP: Moderately severe acute pancreatitis; SAP: Severe acute pancreatitis; MCTSI: Modified computed tomography severity index; HP: Hemoperfusion; CRRT: Continuous renal replacement therapy; TG: Triglyceride; AMY: Amylase; UNL: Upper limit of normal; ICU: Intensive care unit.

Table 2 Comparisons of clinical characteristics and laboratory parameters with different grades of severity of hypertriglyceridemic acute pancreatitis

Characteristic	All (n = 219)	MAP group (n = 29)	MSAP group (n = 114)	SAP group (n = 76)	P value
Sex, n (%)					0.111
Male	140 (63.9)	23 (79.3)	67 (58.8)	50 (65.8)
Female	79 (36.1)	6 (20.7)	47 (41.2)	26 (34.2)
Age, yr	38.92 ± 10.02	38.66 ± 9.73	38.96 ± 10.12	38.96 ± 10.12	0.941
BMI (kg/m²)	26.13 ± 3.30	26.20 ± 1.56	25.58 ± 3.54	28.51 ± 2.97	0.097
Complications, n (%)
Diabetes mellitus	109 (49.8)	14 (48.3)	58 (50.9)	37 (48.7)	0.982
Fatty liver disease	205 (93.6)	25 (86.2)	106 (93.0)	74 (97.4)	0.112
Lipid-lowering treatment, n (%)					< 0.001
Intravenous insulin	84 (38.4)	14 (48.3)	69 (60.5)	1 (1.3)
HP	32 (14.6)	1 (3.4)	26 (22.8)	5 (6.6)
CRRT/HP + CRRT	60 (27.4)	0 (0.0)	1 (0.9)	59 (77.6)
Only anti-lipemic	43 (19.6)	14 (48.3)	18 (15.8)	11 (14.5)
Improved Marshall score	1.00 (0.00, 3.00)	0.00 (0.00, 0.00)	0.00 (0.00, 1.00)	3.00 (3.00, 4.75)	< 0.001
MCTSI score	5.11 ± 1.70	2.14 ± 0.92	5.14 ± 1.06	6.18 ± 1.35	< 0.001
Baseline TG, mg/dL	2713.82 ± 2458.65	1895.15 ± 1685.17	2480.80 ± 2040.458	3386.29 ± 3081.51	0.035
Baseline AMY (nUNL)	2.92 (1.43, 6.41)	2.81 (1.47, 5.21)	2.22 (0.98, 5.08)	5.28 (2.21, 8.66)	< 0.001
CRP, mg/L	196.36 ± 121.97	143.17 ± 97.51	178.65 ± 103.25	247.12 ± 143.73	< 0.001
Albumin, g/L	32.66 ± 5.99	36.48 ± 4.96	34.46 ± 5.16	28.49 ± 5.16	< 0.001
TBIL, mmol/L	16.60 (10.80, 22.90)	18.91 (13.02, 23.68)	15.35 (10.69, 22.46)	16.57 (10.60, 24.92)	0.511
ALT, U/L	20.00 (13.60, 30.70)	21.30 (14.90, 35.75)	20.25 (13.00, 31.93)	19.75 (14.03, 27.30)	0.648
AST, U/L	25.00 (17.50, 39.50)	21.30 (17.00, 28.05)	20.00 (16.08, 30.63)	36.55 (25.00, 56.80)	< 0.001
Total cholesterol, mmol/L	8.58 ± 4.56	7.47 ± 2.96	8.82 ± 4.53	8.64 ± 5.06	0.522
HDL-C, mmol/L	0.82 (0.61, 1.10)	0.88 (0.75, 1.17)	0.86 (0.66, 1.16)	0.69 (0.52, 0.99)	0.241
LDL-C, mmol/L	2.92 ± 1.55	3.77 ± 1.41	2.91 ± 1.58	2.62 ± 1.46	0.003
Glucose, mmol/L	10.50 ± 3.64	9.47 ± 3.70	10.34 ± 3.54	11.13 ± 3.69	0.100
Urea nitrogen, mmol/L	4.73 ± 3.31	4.56 ± 1.63	3.66 ± 1.76	6.40 ± 4.64	< 0.001
Creatinine, μmol/L	83.03 ± 66.48	71.90 ± 18.03	65.46 ± 19.11	113.63 ± 103.46	< 0.001
Calcium, mmol/L	1.93 ± 0.31	2.16 ± 0.18	2.00 ± 0.21	1.75 ± 0.37	< 0.001
WBC, × 10⁹/L	11.67 ± 4.10	11.22 ± 3.64	11.99 ± 4.06	11.37 ± 4.33	0.351
PLT, × 10⁹/L	200.19 ± 69.19	194.69 ± 73.58	208.67 ± 65.17	189.57 ± 72.51	0.159
Hb, g/L	141.11 ± 24.52	143.69 ± 19.12	136.87 ± 22.76	146.49 ± 27.78	0.010
STSH, mIU/L	0.28 (0.16, 0.65)	0.49 (0.28, 0.98)	0.28 (0.14, 0.66)	0.24 (0.16, 0.62)	0.188
FT3, pmol/L	2.29 ± 1.00	2.90 ± 0.77	2.36 ± 0.86	2.89 ± 1.18	0.018
FT4, pmol/L	12.56 ± 3.70	12.83 ± 2.10	12.88 ± 3.95	12.11 ± 3.68	0.302
Admission to ICU, n (%)	98 (44.7)	1 (3.4)	27 (23.7)	70 (92.1)	< 0.001
Death, n (%)	9 (4.1)	0 (0.0)	0 (0.0)	9 (11.8)	< 0.001

MAP: Mild acute pancreatitis; MSAP: Moderately severe acute pancreatitis; SAP: Severe acute pancreatitis; BMI: Body mass index; HP: Hemoperfusion; CRRT: Continuous renal replacement therapy; MCTSI: Modified computed tomography severity index; TG: Triglyceride; AMY: Amylase; UNL: Upper limit of normal; CRP: C-reactive protein; TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate transaminase; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; WBC: White blood cell; PLT: Blood platelet; Hb: Hemoglobin; STSH: Sensitive thyrotropin; FT3: Free triiodothyronine; FT4: Free thyroxine; ICU: Intensive care unit.

Table 3 Factors associated with severe hypertriglyceridemic acute pancreatitis according to multivariate logistic regression analysis

Variable	B	OR	OR (95%CI)	P value
Baseline TG	0.023	1.023	(0.991-1.056)	0.159
Baseline AMY	0.345	1.412	(0.916-2.175)	0.118
CRP	0.110	1.011	(1.003-1.019)	0.005
Albumin	-0.197	0.821	(0.693-0.973)	0.023
AST	0.018	1.018	(0.975-1.063)	0.423
LDL-C	-0.173	0.814	(0.556-1.272)	0.412
Urea nitrogen	-0.334	0.709	(0.462-1.086)	0.114
Creatinine	0.025	1.026	(0.988-1.065)	0.186
Calcium	-4.152	0.016	(0.001-0.239)	0.003
Hb	0.008	1.008	(0.975-1.043)	0.621
FT3	-1.324	0.266	(0.055-1.281)	0.099

OR: Odds ratio; TG: Triglyceride; AMY: Amylase; CRP: C-reactive protein; AST: Aspartate transaminase; LDL-C: Low-density lipoprotein cholesterol; Hb: Hemoglobin; FT3: Free triiodothyronine.

Table 4 Comparisons of clinical characteristics and laboratory parameters with different treatment between intravenous insulin and hemoperfusion before and after propensity score matching

Characteristic	Entire cohort		P value	PSM		P value
Characteristic	INS group (n = 84)	HP Group (n = 32)	P value	INS group (n = 26)	HP group (n = 26)	P value
Sex, n (%)			0.626			0.184
Male	51 (60.7)	21 (65.6)		20 (76.9)	16 (61.5)
Female	33 (39.3)	11 (34.4)		6 (23.1)	10 (38.5)
Age, yr	39.99 ± 10.36	36.44 ± 11.60	0.965	36.81 ± 10.79	36.42 ± 10.10	0.895
Grades of severity, n (%)			0.002			0.755^a
MAP	14 (16.7)	1 (3.1)		1 (3.8)	1 (3.8)
MSAP	69 (82.1)	26 (81.3)		25 (96.2)	25 (96.2)
SAP	1 (1.2)	5 (15.6)		0 (0.0)	0 (0.0)
Improved Marshall score	0.00 (0.00, 1.00)	1.00 (1.00, 2.00)	< 0.001	0.00 (0.00, 1.00)	1.00 (0.00, 1.00)	0.186^a
MCTSI score	4.67 ± 1.59	5.75 ± 0.84	< 0.001	5.15 ± 1.29	5.62 ± 0.80	0.127^a
Baseline TG, mg/dL	2493.20 ± 1958.06	3443.88 ± 1676.31	0.037	3484.64 ± 2275.248	3264.91 ± 2375.37	0.734^a
Treated TG within 48 h, mg/dL	946.25 ± 769.05	1145.60 ± 699.05	0.205	1108.39 ± 856.76	1040.16 ± 686.65	0.753
Clearance rate of TG within 48 h, %	47.65 ± 34.64	63.91 ± 23.32	0.005	57.24 ± 33.70	56.38 ± 33.61	0.927^a
CRP, mg/L	184.75 ± 99.84	198.43 ± 94.00	0.552	214.612 ± 119.22	198.28 ± 97.09	0.629
Albumin, g/L	34.05 ± 4.81	32.50 ± 6.39	0.219	34.56 ± 5.03	32.53 ± 6.58	0.218
TBIL, mmol/L	17.80 ± 8.96	19.83 ± 13.61	0.439	18.70 ± 9.38	20.87 ± 14.41	0.523
ALT, U/L	24.55 ± 17.77	23.15 ± 18.15	0.705	24.58 ± 16.69	21.81 ± 16.47	0.550
AST, U/L	25.70 ± 14.23	30.85 ± 26.87	0.187	24.84 ± 12.40	32.10 ± 29.44	0.252
Total cholesterol, mmol/L	8.38 ± 3.89	8.93 ± 4.37	0.511	9.84 ± 4.91	8.52 ± 4.58	0.318
Glucose, mmol/L	11.08 ± 3.65	10.83 ± 3.42	0.739	11.71 ± 2.74	10.07 ± 3.22	0.057
Urea nitrogen, mmol/L	4.02 ± 1.86	3.83 ± 2.27	0.652	3.54 ± 1.76	3.34 ± 1.94	0.688
Creatinine, mmol/L	63.73 ± 18.23	67.72 ± 24.01	0.338	65.00 ± 12.33	67.00 ± 23.36	0.702
Calcium, mmol/L	1.98 ± 0.25	1.90 ± 0.28	0.100	2.03 ± 0.23	1.89 ± 0.31	0.063
WBC, × 10⁹/L	11.79 ± 4.20	12.33 ± 4.37	0.541	12.40 ± 4.00	12.51 ± 4.44	0.920
PLT, × 10⁹/L	205.39 ± 68.44	204.34 ± 65.98	0.941	201.66 ± 59.77	197.38 ± 57.91	0.795
Hb, g/L	137.48 ± 23.67	138.12 ± 27.60	0.902	143.44 ± 19.50	135.38 ± 27.50	0.230
Length of stay, d	11.88 ± 6.37	11.93 ± 6.01	0.965	13.04 ± 7.92	12.35 ± 6.40	0.730
Death, n (%)	0 (0.0)	0 (0.0)		0 (0.0)	0 (0.0)

^aP value changed after propensity score matching.

PSM: Propensity score matching; INS: Intravenous insulin; HP: Hemoperfusion; MAP: Mild acute pancreatitis; MSAP: Moderately severe acute pancreatitis; SAP: Severe acute pancreatitis; MCTSI: Modified computed tomography severity index; TG: Triglyceride; CRP: C-reactive protein; TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate transaminase; WBC: White blood cell; PLT: Blood platelet; Hb: Hemoglobin.

Citation: Lin XY, Zeng Y, Zhang ZC, Lin ZH, Chen LC, Ye ZS. Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study. World J Gastroenterol 2022; 28(29): 3946-3959
URL: https://www.wjgnet.com/1007-9327/full/v28/i29/3946.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i29.3946