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Clinical features of non-recurrent acute pancreatitis and recurrent acute pancreatitis cases.
Source publication
Hyperlipemia is a well-established etiology of acute pancreatitis. However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and followed the triglyceride management of p...
Contexts in source publication
Context 1
... 1) We next compared the characteristics between patients with non-current acute pancreatitis (non-RAP) and RAP. As it was shown in Table 2, the mean age in patients who had only 1 episode of HTG-AP was 43.18 ± 7.44 years, whereas patients with RAP were younger (P < .05), the mean age was 35.26 ± 6.34 years. Patients who had 4 or more episodes were significantly younger, which was 28.87 ± 3.63 years, P < .05( ...Context 2
... mortality rate in 1 episode of HTG-AP was 4.2%, while it was 6.3% in recurrent cases, but the difference was not statistically significant. (Table 2) For the blood TG levels at admission, the average value was higher in patients with RAP compared to that of non-recurrent cases (1736 ± 273 mg/dL compared to 1279 ± 205 mg/dL, P < .05). The serum TG levels in patients who had 4 or more disease attacks were much higher, the average value was 2213 ± 396 mg/dL, P < .05 ...Similar publications
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Citations
... The serum TG level at 1 month of follow-up was closely associated with HTGP recurrence. Some reports have suggested that serum TG levels after hospital discharge higher than 5.65 mmol/l are independently associated with recurrent pancreatitis (27,28). Even moderately elevated baseline serum TG levels (2.25 mmol/l-5.65 ...
Aim:
To analyze the clinical profile of patients with acute hypertriglyceridemic pancreatitis (HTGP) and explore risk factors for recurrence.
Methods:
A retrospective observational study was conducted in patients who experienced an attack of HTGP for the first time. Patients were followed until the recurrence of acute pancreatitis (AP) or 1 year. The detailed clinical profile was compared between patients with or without recurrence. Multivariate logistic regression analysis was conducted to explore independent risk factors for recurrence.
Results:
A total of 108 HTGP patients were included in this study with 73.1% being male, and the median age being 37 (interquartile range, IQR, 30.3-44.8) years. Recurrence occurred in 70 patients (64.8%). Compared with the nonrecurrent group, serum triglyceride (TG) levels before discharge [4.1 (2.8,6.3) mmol/L vs. 2.9 (2.2,4.2) mmol/L; p = 0.002], at 1 month [3.7 (2.3,9.7) mmol/L vs. 2.0 (1.4,2.7) mmol/L; p = 0.001], at 6 months [6.1 (3.1,13.1) mmol/L vs. 2.5 (1.1,3.5) mmol/L; p = 0.003] and 12 months [9.6 (3.5,20.0) mmol/L vs. 2.7 (1.6,5.5) mmol/L; p = 0.001] after discharge were higher in the recurrent group. Poor control of TG levels (TG > 3.1 mmol/l) at the 1-month follow-up after discharge and a high Charlson's Comorbidity Index score (≥ 2 points) increased the risk of recurrence of HTGP.
Conclusion:
High TG levels during follow-up and Charlson's Comorbidity Index score were independently associated with recurrence in patients with HTGP.
... An understanding of the temporal relationship of clinically evident AP to the diagnosis of CP; therefore, provides an opportunity to intervene in order to prevent or slow disease progression. Modifiable pancreatic-injury risk factors include: alcohol [5], hypertriglyceridemia [6], CFTR dysfunction in pancreas sufficient cystic fibrosis [7], and/or other potential strategies not currently established. Opponents of the SAPE hypothesis argue that histologic changes of CP are found on surgery at the time of the first episode [8] or early in the course of disease [9]. ...
Introduction
The mechanistic definition of chronic pancreatitis (CP) identifies acute pancreatitis (AP) as a precursor stage. We hypothesized that clinical AP frequently precedes the diagnosis of CP and is associated with patient- and disease-related factors. We describe the prevalence, temporal relationship and associations of AP in a well-defined North American cohort.
Methods
We evaluated data from 883 patients with CP prospectively enrolled in the North American Pancreatitis Studies across 27 US centers between 2000 and 2014. We determined how often patients had one or more episodes of AP and its occurrence in relationship to the diagnosis of CP. We used multivariable logistic regression to determine associations for prior AP.
Results
There were 624/883 (70.7%) patients with prior AP, among whom 161 (25.8%) had AP within 2 years, 115 (18.4%) within 3–5 years, and 348 (55.8%) >5 years prior to CP diagnosis. Among 504 AP patients with available information, 436 (86.5%) had >1 episode. On multivariable analyses, factors associated with increased odds of having prior AP were a younger age at CP diagnosis, white race, abdominal pain, pseudocyst(s) and pancreatic duct dilatation/stricture, while factors associated with a lower odds of having prior AP were exocrine insufficiency and pancreatic atrophy. When compared with patients with 1 episode, those with >1 AP episode were diagnosed with CP an average of 5 years earlier.
Conclusions
Nearly three-quarters of patients were diagnosed with AP prior to CP diagnosis. Identifying which AP patients are at-risk for future progression to CP may provide opportunities for primary and secondary prevention.
... Our study shows that dyslipidemia is related to different types of AP, RAP and CP, with OR of 8.40, 10.24 and 2.46 (p < 0.05) respectively, and dyslipidemia is also related to D-Dimer level. In previous studies, dyslipidemia, especially hypertriglyceridemia, is related to AP and RAP 38 , the pathophysiology could be the metabolism of excessive TGs by pancreatic lipase to non-esterified fatty acids (NEFA) leading to pancreatic cell injury and ischemia 39 . A 3558-patient study comparing high triglyceride-AP (HTG-AP) versus non-HTG-AP s reported a statistically significant higher incidence of pancreatic necrosis, infected pancreatic necrosis, organ failure, and persistent organ failure 40 . ...
Abstract This study aims to evaluate levels of D-dimer and serum lipid in different types of pancreatitis, and the relationship between D-dimer and dyslipidemia, especially triglyceride to HDL-C ratio (TG/HDL-C) in different types of pancreatitis. We analyzed the D-dimer and dyslipidemia levels in acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). A single-centered retrospective study was conducted on 1013 patients diagnosed with AP, RAP or CP. Only patients hospitalized within 24 h of onset were included, and 204 patients were enrolled in pancreatitis groups. 68 normal persons without pancreatitis, malignant diseases, pregnancy, or organ failure, who had health check-ups, were enrolled in the control group. Blood samples were taken within 24 h of admission. The relevant information on epidemiology and etiology was collected. D-dimer and serum lipid levels in different types of pancreatitis were analyzed. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction. We found that D-dimer and TG/HDL-C ratio could distinguish mild AP (MAP) and non-MAP in AP and RAP patients. The D-dimer level was related to TG/HDL-C ratio and severity of pancreatitis, with the coefficient correlation of 0.379 and 0.427(p
... [25] One recent research also confirmed that HTG was linked with an increased risk of relapse of clinical AP events. [26] For patients with HTG, long-term management includes dietary intervention, long-term medications, and lifestyle modifications. Some of these individuals may not follow certain pieces of lifestyle modification advice, which then may lead to RAP occurrences. ...
Background:
Acute pancreatitis (AP) is a common digestive disorder with different clinical outcomes, some of which develop into recurrent acute pancreatitis (RAP). This study aimed to explore the differences between AP and RAP.
Methods:
All patients with AP admitted to Changsha Central Hospital between January 2015 and December 2020 were included. Characteristics between RAP and non-RAP groups were compared. Independent factors associated with RAP were identified by multivariate logistic regression analyses.
Results:
This was a retrospective study. A total of 1567 patients, including 262 patients in the RAP group and 1305 patients in the non-RAP group, were enrolled. Compared to the non-RAP group, results indicated that the RAP group was younger (P < 0.001), had a male predominance (P < 0.001), and had higher incidences of diabetes (P < 0.001) and hypertriglyceridemia (HTG) (P < 0.001). Lower incidences of cholelithiasis (P < 0.001) and acute liver injury (P < 0.001) were also noted in the RAP group. Scores of Ranson, BISAP, SOFA, and APACHE II were significantly higher in the non-RAP group (P < 0.001 for all). Three independent factors associated with RAP, including male gender (P = 0.006), diabetes (P < 0.001), and HTG (P < 0.001), were identified by multivariate logistic regression.
Conclusion:
Compared to the non-RAP, the incidence of cholelithiasis and acute liver injury was lower in RAP. Three independent factors associated with RAP, namely male, diabetes, and HTG, were identified.
... Previous studies have suggested that an elevated level of serum TG above 1000 mg/dL significantly increases the risk of HTG-AP, and for every 100 mg/dL increase in TG level, the risk of HTG-AP rises by 4% [8]. Most cases of HTG-AP are single episodic (75.9%), and the incidence of recurrent HTG-AP is even more uncommon (24.1%) [9]. Even though seasonal variation has been proved in the levels of some blood lipids, reports regarding minimum and peak values of serum TG according to the seasons have yielded contradicting results [10]. ...
... In a study by Yan et al. a total of 206 HTG-AP patients were studied. Their data showed that 75.9% of them were single episodic, and only about 24.1% of the cases were associated with two or more episodes [9]. Variation in the level of some lipids, such as cholesterol, has been detected based on seasonal variation. ...
... Some studies have tried to detect minimum and peak values of serum TG levels according to seasonal variation; however, these studies have yielded contradicting results [10]. Most cases of recurrent HTG-AP found in the literature are not annual and have occurred randomly throughout the years, and no association between the reoccurrence and the seasons has been pointed out [5,9,18,19]. The case in the current study is associated with recurrent HTG-AP that occurred annually for the last three years in winter-autumn. ...
Introduction
Acute pancreatitis (AP) is a serious inflammatory condition of the pancreas. Hypertriglyceridemia (HTG) is considered an uncommon cause of AP. The current study aims to present a unique case of recurrent seasonal severe HTG-induced AP (HTG-AP); treated with insulin and heparin.
Case report
A 36-year-old male presented with recurrent attacks of severe upper abdominal pain that was radiating to the back and associated with repeated vomiting. The condition has being occurring every autumn-winter for the last three years. He had Thalassemia minor and had a history of HTG-AP. His TG levels were relatively normal from February to August; however, from September to February, his TG levels highly elevated which has resulted in HTG-AP every year for the past three years. The condition was confirmed via a contrast-enhanced computerized tomography scan of the abdomen. To prevent the next HTG-AP, his TG level was monitored monthly. When TG levels spiked again, the patient was put on an insulin infusion with heparin, glucose, and potassium to rapidly reduce TG level. After two days, serum TG was dramatically reduced (<500 mg/dL).
Discussion
Despite multiple theories being proposed, the pathogenesis of HTG-AP is yet to be understood. Usually, HTG-AP is a single episodic, and recurrent HTG-AP is considered uncommon finding. Previous reports are contradictory regarding TG level and seasonal variation. There is currently no standard management approach to treat HTG-AP cases.
Conclusion
HTG-AP rarely reoccurs on an annual basis, and seasonal variation seems to play a major role in its onset. The condition can be managed with insulin, heparin, and glucose infusions.
... However, it is postulated that it may be secondary to increased conversion of excessive triglycerides to free fatty acids by pancreatic lipase ultimately leading to pancreatic ischemia and acinar cell injury [5]. Furthermore, patients with HTG-AP have a higher likelihood of progression to severe disease and prolonged hospital course [16,17]. ...
Background:
Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis often leading to significant morbidity, mortality, and healthcare burden. This study aimed to describe the rate, reasons, and predictors of HTG-induced acute pancreatitis (HTG-AP) in the USA.
Methods:
This retrospective study analyzed the Nationwide Readmissions Database (NRD) for 2018 to determine all adults (≥ 18 years) readmitted within 30 days of an index hospitalization of HTG-AP. Hospitalization characteristics and adverse outcomes for 30-day readmissions were highlighted and compared with index admissions of HTG-AP. Furthermore, independent predictors for 30-day readmissions of HTG-AP were also identified. P values ≤ 0.05 were considered statistically significant.
Results:
In 2018, the rate of 30-day readmission of HTG-AP was noted to be 13.5%. At the time of readmission, AP (45.2%) was identified as the most common principal diagnosis, followed by chronic pancreatitis (6.3%) and unspecified sepsis (4.8%). Compared to index admissions, 30-day readmissions of HTG-AP had a higher proportion of patients with Charlson Comorbidity Index (CCI) scores ≥ 3 (48.5% vs. 33.8%, P < 0.001). Furthermore, we noted higher rates of inpatient mortality (1.7% vs. 0.7%, odds ratio (OR): 2.55, 95% confidence interval (CI): 1.83 - 3.57, P < 0.001), mean length of stay (LOS) (5.6 vs. 4.1 days, OR: 1.5, 95% CI: 1.2 - 1.7, P < 0.001), and mean total healthcare charge (THC) ($56,799 vs. $36,078, OR: 18,702, 95% CI: 15,136 - 22,267, P < 0.001) for 30-day readmissions of HTG-AP compared to index admissions. Independent predictors for 30-day all-cause readmissions of HTG-AP included hypertension, protein energy malnutrition (PEM), CCI scores ≥ 3, chronic kidney disease and discharge against medical advice.
Conclusions:
AP was the principal diagnosis on presentation in only 45.2% patients for 30-day readmissions of HTG-AP. Compared to index admissions, 30-day readmissions of HTG-AP had a higher comorbidity burden, inpatient mortality, mean LOS and mean THC.
... Some studies have also reported significantly high lipid levels in middle-aged or younger individuals. 44,45 Therefore, it remains to be determined why the lipid levels were higher in younger patients than in older ones. The reasons may be as follows: (a) long-term unhealthy working conditions and lifestyles among young working-age adults can easily induce hyperlipidemia. ...
Purpose
We aimed to investigate the association between lipid profiles and diabetic retinopathy (DR).
Patients and Methods
This case-control study, which was conducted between November 2019 and August 2021, comprised 309 patients with DR, 186 patients with diabetes mellitus, and 172 healthy controls. Serum cholesterol (CHOL), triglyceride (TRIG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (SDLDL-C), apolipoprotein A (APOA), APOB, APOE and lipoprotein (a)(LPA) levels were assessed. Patients were divided into two groups according to median age and glycated hemoglobin (HbA1c) level. Linear and logistic regression analyses were performed to assess the association between lipid levels and DR.
Results
CHOL, TRIG, HDL-C, APOB, APOE, and SDLDL-C levels were significantly higher in the DR group than in the healthy control group, and TRIG levels were lower in the DR group than in the DM group (P < 0.05), especially in the ≤57-year-old and the HbA1c ≤7.2% subgroups. Linear regression analyses showed that CHOL, TRIG, APOA, APOB, APOE, and SDLDL-C levels were associated with HbA1c levels. Multivariable logistic regression analyses indicated that CHOL (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.112–1.566), TRIG (OR = 1.269, 95% CI = 1.030–1.563), HDL-C (OR = 43.744, 95% CI = 17.12–111.769), APOB (OR = 7.037, 95% CI = 3.370–14.695), APOE (OR = 1.057, 95% CI = 1.038–1.077), and SDLDL-C (OR = 14.719, 95% CI = 8.304–26.088) levels were risk factors for DR (P < 0.05).
Conclusion
Increased lipid levels were risk factors for DR, and lipid level control should be strengthened, especially in younger adults or in patients with HbA1c ≤7.2%.
Background
Severe hypertriglyceridemia (sHTG) is associated with an increased risk of acute pancreatitis. Prompt recognition and treatment of sHTG is key for prevention of acute pancreatitis and its associated life-threatening complications.
Local problem
Patients with sHTG at a primary care clinic within the Veterans Affairs Eastern Colorado Health Care System were receiving suboptimal treatment that did not align with evidence-based guidelines.
Methods
We initiated a quality improvement (QI) project to improve the management of sHTG in an outpatient primary care clinic. Veterans with a triglyceride level between 500 and 1,500 mg/dl were included in the project.
Interventions
Project interventions included provider education, patient education, and targeted electronic consultations (e-consults) with treatment recommendations. The primary outcome was to decrease the percentage of patients with triglycerides ≥500 mg/dl by 25%. The secondary outcome was to decrease the mean triglyceride level of the patient population by 15%.
Results
Education on evaluation and treatment of sHTG was given to 100% ( n = 21) of primary care clinicians. Overall, 72.8% (95% CI [62.6–81.6%]) of patients ( n = 67) received appropriate written education materials, and 72.8% (95% CI [62.6–81.6%]) of patients ( n = 67) received a targeted e-consult. The percentage of patients with sHTG decreased by 47%. Average triglyceride level decreased from 651 to 483 mg/dl (25.8% decrease).
Conclusion
A multipronged QI project consisting of provider education, patient education, and targeted e-consults resulted in decreased triglyceride levels and improved access to specialist expertise. Clinical implications include decreased prevalence of sHTG and risk of acute pancreatitis among patients in the project.
Background
: Hypertriglyceridemia (HTG) is known as the third most common cause of acute pancreatitis (AP).
Objective
: To study the prevalence and outcomes of HTG-AP as well as the quality of the follow-up post HTG-AP hospitalization in Canada.
Methods
: This retrospective multicenter study was performed in patients admitted with AP (ICD 10 code K85) in quaternary care hospitals between 2012 and 2018. For every case of HTG-AP (TG ≥ 5.6 mmol/L on admission), two controls of biliary-AP were selected and matched for sex and age at the time of admission.
Results
: Out of 1490 admitted AP patients, 40 (3%) had HTG-AP. The average TG concentration was higher in patients admitted to the ICU compared to those who were not (27.34 mmol/L vs 13.02 mmol/L). Compared to biliary-AP group, the HTG-AP patients had more frequent severe Balthazar grade (45% vs 25%) with longer duration of hospitalisation (nine versus five days) and more frequent ICU admission (38% vs 8%). Furthermore, only 35% of HTG-AP patients were referred to specialized clinics and 42.5% were left with no follow-up. Only 17% of newly discovered HTG-AP patients were started on fibrate at discharge.
Conclusion
: In comparison to biliary-AP, HTG-AP patients had a worse clinical course of pancreatitis. Furthermore, the quality of the follow-up post HTG-AP hospitalization was suboptimal. This could be explained by of the lack of knowledge of health care providers concerning the proper diagnosis and management of chylomicronemia syndromes, leading to this condition to be frequently missed or underdiagnosed.
Background
This study aims to evaluate the relationship between D-dimer and dyslipidemia, especially triglyceride to HDL-C ratio (TG/HDL-C) in different types of pancreatitis. We analyzed the D-dimer and dyslipidemia levels in acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP).
Material and Methods
A single-centered retrospective study was conducted on 1013 patients diagnosed with AP, RAP or CP. Only patients hospitalized within 24 h of onset were included, and 204 patients were enrolled in pancreatitis groups. 68 normal persons without pancreatitis, malignant diseases, pregnancy, or organ failure, who had health check-ups, were enrolled in the control group. Blood samples were taken within 24h of admission. The epidemiology and etiology were analyzed. D-dimer and dyslipidemia levels were compared between different types of pancreatitis. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction.
Results
We found that D-dimer and TG/HDL-C ratio could distinguish mild AP (MAP) and non-MAP in AP and RAP patients. The D-dimer level was related to TG/HDL-C ratio and severity of pancreatitis, with the coefficient correlation of 0.379 and 0.427(p<0.01), respectively. TG/HDL-C was related to D-dimer in different types of pancreatitis. Multivariate analysis was conducted in the parameters at admission like alcohol abuse, dyslipidemia and coagulation disturbance in distinguishing AP and RAP groups from the control group, and the parameter like diabetes in RAP and CP groups significantly increased compared with that of the control group.
Conclusions
The value of D-dimer level and TG/HDL-C ratio in predicting the severity of AP and RAP was confirmed but there was no significant difference between CP group and the control group. The D-dimer level was related to dyslipidemia and TG/HDL-C ratio.
