Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2022; 28(29): 3946-3959
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.3946
Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study
Xue-Yan Lin, Yi Zeng, Zheng-Chao Zhang, Zhi-Hui Lin, Lu-Chuan Chen, Zai-Sheng Ye
Xue-Yan Lin, Zhi-Hui Lin, Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
Yi Zeng, Lu-Chuan Chen, Zai-Sheng Ye, Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
Zheng-Chao Zhang, Department of Emergency Surgery, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
Author contributions: Lin XY, Zeng Y, and Zhang ZC contributed equally to the work; Lin XY, Zeng Y, and Zhang ZC designed the study, collected and analyzed the data, and wrote the manuscript; Lin ZH, Chen LC, and Ye ZS made contributions to conception, design, and coordination of the study and gave final approval of the version to be published; All authors read and approved the final manuscript.
Institutional review board statement: The Ethics Committee of Fujian Provincial Hospital approved the study (K2021-02-007).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zai-Sheng Ye, PhD, Attending Doctor, Surgical Oncologist, Teacher, Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Fuzhou 350014, Fujian Province, China. flyingengel@sina.cn
Received: December 6, 2021
Peer-review started: December 6, 2021
First decision: April 16, 2022
Revised: April 25, 2022
Accepted: June 30, 2022
Article in press: June 30, 2022
Published online: August 7, 2022
Processing time: 239 Days and 21.8 Hours
Abstract
BACKGROUND

The incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased yearly, but updated population-based estimates on the incidence of HTG-AP are lacking. Reducing serum triglyceride (TG) levels quickly is crucial in the early treatment of HTG-AP. Decreased serum TG levels are treated by non-invasive methods, which include anti-lipidemic agents, heparin, low-molecular weight heparin, and insulin, and invasive methods, such as blood purification including hemoperfusion (HP), plasmapheresis, and continuous renal replacement therapy. However, authoritative guidelines have not been established. Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.

AIM

To evaluate the effect between patients treated with intravenous insulin (INS) and HP to guide clinical treatment.

METHODS

We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP. Propensity score matching was used to compare the clinical outcomes of INS and HP.

RESULTS

A total of 371 patients met the HTG-AP criteria. The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years (8.4% in April 2012-March 2013 and 22.3% in April 2020-March 2021). The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years. The amylase level was elevated in 80.1% of patients but was only three times the normal value in 46.9% of patients. The frequency of severe acute pancreatitis (26.9%), organ failure (31.5%), rate of recurrence (32.9%), and mortality (3.0%) of HTG-AP was high. Improved Marshall score, modified computed tomography severity index score, baseline TG, baseline amylase, C-reactive protein (CRP), albumin, aspartate aminotransferase, low-density lipoprotein cholesterol, urea nitrogen, creatinine, calcium, hemoglobin, free triiodothyronine, admission to intensive care unit, and mortality were significantly different between patients with different grades of severity (P < 0.050). Multivariate logistic regression analysis confirmed that high CRP [P = 0.005, odds ratio (OR) = 1.011, 95%CI: 1.003-1.019], low calcium (P = 0.003, OR = 0.016, 95%CI: 0.001-0.239), and low albumin (P = 0.023, OR = 0.821, 95%CI: 0.693-0.973) were risk factors of severe HTG-AP. After propensity score matching adjusted by sex, age, severity of HTG-AP, and baseline TG, the serum TG significantly decreased in patients treated with INS (P < 0.000) and HP (P < 0.000) within 48 h. However, the clearance rate of TG (57.24 ± 33.70% vs 56.38 ± 33.61%, P = 0.927) and length of stay (13.04 ± 7.92 d vs 12.35 ± 6.40 d, P = 0.730) did not differ between the two groups.

CONCLUSION

The incidence of HTG-AP exhibited a significant increase, remarkable severity, and recurrent trend. Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

Keywords: Hypertriglyceridemic acute pancreatitis; Triglyceride; Improved Marshall score; Severity of acute pancreatitis; Intravenous insulin; Hemoperfusion

Core Tip: We assessed the clinical characteristics of hypertriglyceridemic acute pancreatitis, determined factors related to grades of severity, and evaluated differences in clinical outcomes between patients treated with intravenous insulin and hemoperfusion to guide clinical diagnosis and treatment.