Table 2 - available via license: CC BY
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Source publication
Aim
. To investigate the characteristic of hypertriglyceridemic- (HTG-) induced pancreatitis (HTG pancreatitis).
Methods
. We reviewed 126 cases of HTG pancreatitis and 168 cases of biliary pancreatitis as control.
Results
. The HTG group mean age was younger than biliary group. The number of females was a little higher than males in both groups. T...
Contexts in source publication
Context 2
... common comorbidity in HTG pancreatitis in groups was diabetes mellitus (26/126), hypertension (8/126), and coronary heart disease (3/126) as shown in Table 2. The comorbidity of DM in HTG pancreatitis group was evidently higher than biliary pancreatitis group (20.6% versus 6.5%) as shown in Table 2. ...
Context 3
... common comorbidity in HTG pancreatitis in groups was diabetes mellitus (26/126), hypertension (8/126), and coronary heart disease (3/126) as shown in Table 2. The comorbidity of DM in HTG pancreatitis group was evidently higher than biliary pancreatitis group (20.6% versus 6.5%) as shown in Table 2. There is report that the patients with HTG have more possibility of DM [24]. ...
Citations
... The frequency of acute hypertriglyceridemic pancreatitis (AHTGP) as a type of AP is increasing worldwide [2]. One multicenter study conducted in Beijing found that AHTGP was present in 10.36% of patients with AP [3,4]. Furthermore, some evidence suggests that AHTGP may be associated with a more severe clinical course and greater mortality than pancreatitis caused by other causes [1,5,6]. ...
Background:
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.
Aim:
To develop and validate a risk prediction score for the severity of AHTGP in Chinese patients.
Methods:
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.
Results:
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.
Conclusion:
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.
... Tai et al also found higher recurrence rate of HTGP than ABP. 25 HTGP is often associated with multiple factors (metabolic abnormalities, lack of exercise, alcohol intake, microcirculation disorders) and is more severe and has a worse prognosis than other causes, which may also contribute to its higher recurrence rate. We also found a proportion of patients with pancreas congenital malformation in the RAP group. ...
Background
In recent years, the cure rate of acute pancreatitis (AP) has increased gradually, but the morbidity of recurrent acute pancreatitis (RAP) has not decreased. Patients with RAP have a poor quality of life and are more likely to develop into chronic pancreatitis. To investigate the risk factors of RAP after first pancreatitis attack is very necessary.
Methods
Patients with first episode AP admitted to Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to May 2021 were included in this retrospective study, and follow-up was 3–45 months after discharge. The patients information were collected from medical records including laboratory tests and auxiliary inspection of their hospitalization. Univariate and multivariate Cox regression analysis were used to explore the risk factors of RAP. Cumulative risk of RAP was plotted using Kaplan–Meier curves.
Results
A total of 592 patients were enrolled in the study and 81 (13.7%) of the patients developed RAP. Among those RAP patients, the majority (67.9%) were men, with a median age of 43 years. The most common etiology of RAP was hypertriglyceridemia (38.3%). Multivariate Cox analysis showed that smoking history (p < 0.001), infected pancreatic necrosis occurred during first admission (p = 0.005), and high low-density lipoprotein cholesterol (LDLc) level (p < 0.001) were significant independent risk factors for RAP. Patients with the above independent risk factors had increased 3-year cumulative risk of recurrence (32.2%, 45.5%, 28.9%, respectively).
Conclusion
Smoking history, infected pancreatic necrosis, and high LDLc level were the most decisive risk factors for RAP. Attention should be paid to the patients with the above factors.
... 9 HTGP is associated with more complications, a longer and more severe disease, and a higher recurrence rate. 7,12,13 Therefore, it is important to distinguish the etiology of AP. ...
Background
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.
Methods
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.
Results
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.
Conclusion
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.
... Numerous studies [5,[12][13][14][15][16][17][18] show that HTG-AP is characterized by younger patient age, male sex, higher fat intake and higher BMI, as well as the incidence of complications (renal failure, shock, and infection) and length of hospital stay compared with patients with pancreatitis due to other etiologies. Of particular note, when HTG-AP is accompanied by another condition (alcohol consumption and cholelithiasis), the incidence of persistent organ failure is significantly higher than that of HTG-AP alone [19]. ...
In recent years, the number of acute pancreatitis cases caused by hypertriglyceridemia has increased gradually, which has caught the attention of the medical community. However, because the exact mechanism of hypertriglyceridemic acute pancreatitis (HTG-AP) is not clear, treatment and prevention in clinical practice face enormous challenges. Animal models are useful for elucidating the pathogenesis of diseases and developing and testing novel interventions. Therefore, animal experiments have become the key research means for us to understand and treat this disease. We searched almost all HTG-AP animal models by collecting many studies and finally collated common animals such as rats, mice and included some rare animals that are not commonly used, summarizing the methods to model spontaneous pancreatitis and induce pancreatitis. We sorted them on the basis of three aspects, including the selection of different animals, analyzed the characteristics of different animals, different approaches to establish hypertriglyceridemic pancreatitis and their relative advantages and disadvantages, and introduced the applications of these models in studies of pathogenesis and drug therapy. We hope this review can provide relevant comparisons and analyses for researchers who intend to carry out animal experiments and will help researchers to select and establish more suitable animal experimental models according to their own experimental design.
... More importantly, there may be a dose-response relationship between hypertriglyceridemia and the severity and complications of AP [2]. The incidence of hypertriglyceridemic acute pancreatitis (HLAP) is gradually increasing [3,4], and its associated mortality can exceed 30% [5]. ...
Background
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.
Methods
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.
Results
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).
Conclusions
TC could be a potential biomarker to predict the effects of TG-lowing therapy in patients with HLAP.
... Assessment of Computed [7,20,21]. Therefore, it is important to distinguish the etiology of AP. The aim of the present study was to assess the impact of body composition on the length of hospital stay (LOS) and risk of recurrence of HTGP. ...
Background: 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.
Methods: 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.
Results: 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 fat area (SFA) (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 SFA 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.
Conclusion: SFA 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.
... Zhu et al. (8) and Deng et al. (42) confirmed that HTG-AP is accompanied by a significantly higher rate of mortality among severe AP cases compared to biliary AP and non-HTG etiology, respectively. However, Tai et al. (32) showed that mortality was similar in HTG-AP and biliary AP groups in a general AP cohort. ...
... Similarly, in a previous study, we did not find differences in MOF among HTG-AP vs. non-HTG-AP patients 147 . Tai et al. 149 also found a higher risk for the severe form of AP in HTG-AP patients compared to BAP. They diagnosed MOF more frequently in BAP patients, however, there was no difference in single OFs (renal, heart, pulmonary). ...
... In our study, alcoholic and hypertriglyceridaemic aetiologies caused more AP recurrence than biliary, while the repeated hospitalization for AAP and HTG-AP patients was similar. Tai et al. also found higher recurrence rate of HTG-AP than BAP 149 . Other studies drew the conclusion that alcohol is the most frequent aetiological factor for recurrent AP 150,151 . ...
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.
... After gallstones (up to 60%) and alcohol (30%), hypertriglyceridemia is the third most common cause of AP, accounting for nearly 10% of all cases [2]. The incidence of hypertriglyceridemic acute pancreatitis (HLAP) is gradually increasing [3,4], and its associated mortality can exceed 30% [5]. ...
Background
The clinical efficacy of plasmapheresis (PP) in patients with hypertriglyceridemic acute pancreatitis (HLAP) might affected by total cholesterol (TC). The objective of this study is to determine the relationship of TC and the Triglyceride (TG)-lowing effect in patients on either non-PP or PP therapy.
Methods
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 500mg/dl within 48 hours. Linear mixed-effect model and logistic regression analyses were used to assess the association of TC and different therapy groups on TG-lowing efficacy.
Results
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, primary outcome occurred in 81.25% of patients in the PP group, and 62.30% in the non-PP group (adjusted OR 2.05; 95% CI 0.45–9.40; p = 0.353).
Conclusions:
TC could be a potential biomarker to predict the effects of TG-lowing therapy in patients with HLAP.
... AHTGP is typically seen in patients with one or more secondary factors (uncontrolled diabetes, alcohol abuse, special medications/oral estrogen, and certain pregnancy durations) and abnormal lipoprotein metabolism (familial hyperlipidemia or HTG). The frequency of HTGP as the etiology of AP is increasing worldwide (3,16). The mechanism by which HTG causes HTGP is unknown; however, the most widely accepted hypothesis is that hydrolysis of excess TG by pancreatic lipase results in the accumulation of free fatty acids (FFAs). ...
Background/aims:
The aim of this study was to investigate the relationship between the triglyceride (TG) level and the severity of acute hypertriglyceridemic pancreatitis (AHTGP) in Chinese patients.
Materials and methods:
On the basis of clinical data on AHTGP, patients from the period 2015-2018 were enrolled retrospectively and grouped according to the 2012 revised Atlanta classification. Kruskal-Wallis test was performed to evaluate differences among groups. Receiver operating characteristic (ROC) curves were generated to assess the ability of parameters to distinguish mild acute pancreatitis (MAP)/moderately severe acute pancreatitis (MSAP) from severe acute pancreatitis (SAP).
Results:
A total of 104 patients with AHTGP were enrolled and divided into three groups: 61 patients with MAP, 29 patients with MSAP, and 14 patients with SAP. The median values for the MAP, MSAP, and SAP groups were as follows: TG level 48 h after admission, 3.4, 4.5, and 14.2 mmol/L, respectively (p<0.001); ratio of TG level 48 h after admission to that 0 h after admission (48:0-h ratio), 19.4, 32.1, and 65.9, respectively (p<0.001). ROC curves showed that the areas under the curves for the TG level 48 h after admission and the TG 48:0-h ratio for predicting SAP were 0.965 and 0.917, respectively (p<0.001), and the optimal cut-off values were 7.8 mmol/L and 37.7, respectively.
Conclusion:
The TG level 48 h after admission and the TG 48:0-h ratio may predict the severity of AHTGP, and a high TG level 48 h after admission may be correlated with the progression of SAP.
