Elevated Serum Triglycerides in the Prognostic Assessment of Acute Pancreatitis

Wang, Qian; Wang, Gang; Qiu, Zhaoyan; He, Xianli; Liu, Chaoxu

doi:10.1097/mcg.0000000000000846

Cited by 81 publications

(80 citation statements)

References 33 publications

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“…This include higher occurrence of renal failure, respiratory failure, shock, systemic inflammatory response syndrome and higher Acute Physiology and Chronic Health Evaluation (APACHE‐II) scores . Higher mortality rates are also reported for acute pancreatitis secondary to severe HTG , suggesting that HTG aggravates pancreatitis episodes. On the other hand, atherosclerotic cardiovascular disease (ASCVD) is considered to be a rare complication of FCS.…”

Section: Evidence Used In This Reviewmentioning

confidence: 99%

“…Acute pancreatitis can be fatal with an overall mortality rate of ~ 6% , but can reach as high as 10–30% if severe complications are present . Although there is no correlation between the absolute maximal TG value and more severe pancreatitis episodes , a recent systematic review and meta‐analysis of observational studies found that HTG‐induced acute pancreatitis is associated with a worse prognosis compared to pancreatitis of other aetiology . This include higher occurrence of renal failure, respiratory failure, shock, systemic inflammatory response syndrome and higher Acute Physiology and Chronic Health Evaluation (APACHE‐II) scores .…”

Section: Evidence Used In This Reviewmentioning

confidence: 99%

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Familial chylomicronemia syndrome: an under‐recognized cause of severe hypertriglyceridaemia

et al. 2020

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Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive disorder of chylomicron metabolism causing severe elevation of triglyceride (TG) levels (>10 mmol L−1). This condition is associated with a significant risk of recurrent acute pancreatitis (AP). AP caused by hypertriglyceridaemia (HTG) has been associated with a worse prognosis and higher mortality rates compared to pancreatitis of other aetiology. Despite its association with poor quality of life and increased lifelong risk of HTG‐AP, few healthcare providers are familiar with FCS. Because this condition is under‐recognized, the majority of FCS patients are diagnosed after age 20 often after consulting several physicians. Although other forms of severe HTG such as multifactorial chylomicronemia have been associated with high atherosclerotic cardiovascular disease (ASCVD) risk and metabolic abnormalities, ASCVD and metabolic syndrome are not usually observed in FCS patients. Because FCS is a genetic condition, the optimal diagnosis strategy remains genetic testing. The presence of bi‐allelic pathogenic mutations in LPL, APOC2, GPIHBP1, APOA5 or LMF1 genes confirms the diagnosis. However, some cases of FCS caused by autoantibodies against LPL or GPIHBP1 proteins have also been reported. Furthermore, a clinical score for the diagnosis of FCS has been proposed but needs further validation. Available treatment options to lower triglycerides such as fibrates or omega‐3 fatty acids are not efficacious in FCS patients. Currently, the cornerstone of treatment remains a lifelong very low‐fat diet, which prevents the formation of chylomicrons. Finally, inhibitors of apo C‐III and ANGPTL3 are in development and may eventually constitute additional treatment options for FCS patients.

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Section: Evidence Used In This Reviewmentioning

confidence: 99%

Section: Evidence Used In This Reviewmentioning

confidence: 99%

Familial chylomicronemia syndrome: an under‐recognized cause of severe hypertriglyceridaemia

et al. 2020

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“…Triglyceride, the main form of energy storage in the body, is stored in adipose tissue which is involved in a range of processes such as energy balance and fatty acids metabolism. Triglycerides are ester molecules derived from glycerol and three fatty acids 28 – 31 . Apoptosis is a process of programmed cell death that occurs in multicellular organisms 32 , 33 , which involve coordinated regulation of a broad range of genes.…”

Section: Discussionmentioning

confidence: 99%

MiR-152 Regulates Apoptosis and Triglyceride Production in MECs via Targeting ACAA2 and HSD17B12 Genes

Yang

Fang

Yang

et al. 2018

Sci Rep

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Mammary epithelial cells (MECs) affect milk production capacity during lactation and are critical for the maintenance of tissue homeostasis. Our previous studies have revealed that the expression of miR-152 was increased significantly in MECs of cows with high milk production. In the present study, bioinformatics analysis identified ACAA2 and HSD17B12 as the potential targets of miR-152, which were further validated by dual-luciferase repoter assay. In addition, the expressions of miR-152 was shown to be negatively correlated with levels of mRNA and protein of ACAA2, HSD17B12 genes by qPCR and western bot analysis. Furthermore, transfection with miR-152 significantly up-regulated triglyceride production, promoted proliferation and inhibited apoptosis in MECs. Furthermore, overexpression of ACAA2 and HSD17B12 could inhibit triglyceride production, cells proliferation and induce apoptosis; but sh234-ACAA2-181/sh234-HSD17B12-474 could reverse the trend. These findings suggested that miR-152 could significantly influence triglyceride production and suppress apoptosis, possibly via the expression of target genes ACAA2 and HSD17B12.

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“…In a retrospective analysis of a large cohort with a triglyceride measurement of >500 mg/dl, the group with follow-up triglyceride values of <400 mg/dl were associated with a significantly lower rate of pancreatitis, indicating that the lower the triglyceride levels can be reduced the less likely will be the risk of pancreatitis (121). Furthermore in a meta-analysis of 15 studies that compared patients with HTG-induced pancreatitis and those with non-HTG-related pancreatitis, HTG-related pancreatitis was associated with an increased odds ratio for renal failure (OR 3.18), respiratory failure (OR 2.88), shock (OR 3.78) and mortality (OR 1.90), thus providing strong evidence for worse outcome when pancreatitis results from severe HTG (122).…”

Section: Complications Of the Chylomicronemia Syndromementioning

confidence: 99%

A Comprehensive Update on the Chylomicronemia Syndrome

Goldberg

Chait

2020

Front. Endocrinol.

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The chylomicronemia syndrome is characterized by severe hypertriglyceridemia and fasting chylomicronemia and predisposes affected individuals to acute pancreatitis. When due to very rare monogenic mutations in the genes encoding the enzyme, lipoprotein lipase, or its regulators, APOC2, APOA5, GPIHBP1, and LMF1, it is referred to as the familial chylomicronemia syndrome. Much more frequently, the chylomicronemia syndrome results from a cluster of minor genetic variants causing polygenic hypertriglyceridemia, which is exacerbated by conditions or medications which increase triglyceride levels beyond the saturation point of triglyceride removal systems. This situation is termed the multifactorial chylomicronemia syndrome. These aggravating factors include common conditions such as uncontrolled diabetes, overweight and obesity, alcohol excess, chronic kidney disease and pregnancy and several medications, including diuretics, non-selective beta blockers, estrogenic compounds, corticosteroids, protease inhibitors, immunosuppressives, antipsychotics, antidepressants, retinoids, L-asparaginase, and propofol. A third uncommon cause of the chylomicronemia syndrome is familial forms of partial lipodystrophy. Development of pancreatitis is the most feared complication of the chylomicronemia syndrome, but the risk of cardiovascular disease as well as non-alcoholic steatohepatitis is also increased. Treatment consists of dietary fat restriction and weight reduction combined with the use of triglyceride lowering medications such as fibrates, omega 3 fatty acids and niacin. Effective management of aggravating factors such as improving diabetes control, discontinuing alcohol and replacing or reducing the dose of medications that raise triglyceride levels is essential. Importantly, many if not most cases of the chylomicronemia syndrome can be prevented by effective identification of polygenic hypertriglyceridemia in people with conditions that increase its likelihood or before starting medications that may increase triglyceride levels. Several new pharmacotherapeutic agents are being tested that are likely to considerably improve treatment of hypertriglyceridemia in people at risk.

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Elevated Serum Triglycerides in the Prognostic Assessment of Acute Pancreatitis

Abstract: Elevated serum TGs are related to a worse prognosis of AP.

Cited by 81 publications

References 33 publications

Familial chylomicronemia syndrome: an under‐recognized cause of severe hypertriglyceridaemia

Familial chylomicronemia syndrome: an under‐recognized cause of severe hypertriglyceridaemia

MiR-152 Regulates Apoptosis and Triglyceride Production in MECs via Targeting ACAA2 and HSD17B12 Genes

A Comprehensive Update on the Chylomicronemia Syndrome

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