Elevated triglycerides on admission positively correlate with the severity of hypertriglyceridaemic pancreatitis

Lu, Zhihua; Zhang, Ge; Guo, Feng; Li, Man; Ding, Ying; Zheng, Huijun; Wang, Donghai

doi:10.1111/ijcp.13458

Cited by 9 publications

(4 citation statements)

References 28 publications

(62 reference statements)

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“…Similar second messenger release mechanisms are induced in alcohol-associated acute pancreatitis by fatty acid ethyl esters (FAEEs) [81], and by fatty acids released from FAEEs or lipolysis of triglycerides in hypertriglyceridaemia [82], to inhibit mitochondria and aerobic ATP production. In general, there is a direct correlation between the severity of toxin exposure and that of acute pancreatitis, as in the case of serum triglyceride levels and the severity of acute pancreatitis [39,43,83].…”

Section: Pathophysiologymentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

210

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Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal crosssectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.

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Section: Pathophysiologymentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

210

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“…Acute pancreatitis (AP) is one of the most common gastrointestinal diseases leading to hospital admissions 1 . The important role of hypertriglyceridemia in AP is increasingly recognized 2 . It is generally believed that triglyceride (TG) levels more than 11.3 mmol/L (1000 mg/dL) is needed to trigger an episode of AP 3 .…”

Section: Introductionmentioning

confidence: 99%

The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis

Chen

et al. 2020

J of Clinical Apheresis

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Introduction The role of double filtration plasmapheresis (DFPP) in hypertriglyceridemic pancreatitis (HTGP) is still not well established. Our study aimed to investigate the efficacy of DFPP in reducing triglyceride levels as well as their effects on the outcomes of HTGP. Material and methods We retrospectively evaluated the data of patients with HTGP presenting within 72 hours from symptom onset between January 2016 and February 2019. Patients with DFPP treatment were compared with those without DFPP treatment. We used a propensity score matching analysis to reduce confounding factors. Results Of the 249 patients enrolled, 88 (35.3%) were treated with DFPP. The DFPP was initiated at a median of 7.7 hours from the time of presentation. In the propensity score‐matched cohort (n = 100), patients with DFPP had a significantly lower level of triglyceride (P = .034), higher triglyceride reduction (P = .005), and the proportion of triglyceride <5.65 mmol/L (P = .002) by 24 hours after admission when compared with those without DFPP. However, this efficacy did not last until 48 hours after admission. No differences were found in terms of the majority of the clinical outcomes between the two groups, including persistent organ failure (P = .098), local complications (P = .213), hospital stay (P = .657), and in‐hospital mortality (P > .999). Conclusions HTGP patients with early initiation of DFPP were associated with rapidly and efficiently reduction of triglyceride levels compared with those without DFPP. However, DFPP showed no beneficial effects on improving the clinical outcomes of HTGP.

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“…Pancreatic necrosis, infected necrosis, organ failure, and persistent organ failure were all more frequent than patients without HTGP. Mortality and ICU length of stay was higher in HTGP patients [11]. A recent cohort study in China showed that with the increase of HTG, the mortality rate of patients and other clinical outcomes of organ failure and pancreatic necrosis increased significantly and gradually, which suggested that triglyceride levels were positively correlated with disease severity.…”

Section: Clinical Course and Natural Historymentioning

confidence: 94%

Research on the clinical treatment of hypertriglyceridemia and acute pancreatitis

2023

FMSR

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Hypertriglyceridemia is the third most common cause of acute pancreatitis in the world [1]. In China, hypertriglyceridemia is gradually rising as the second leading cause of acute pancreatitis [2]. The disease usually occurs in patients with an underlying disorder of lipoprotein metabolisms and secondary conditions such as poorly controlled diabetes mellitus, alcohol abuse, or particular drug use. The clinical manifestations of pancreatitis caused by hypertriglyceridemia are generally similar to acute pancreatitis caused by other causes. However, patients with pancreatitis caused by hypertriglyceridemia may have a longer course of the disease and more complications [3], accompanied by a higher possibility of persistent organ failure. The initial treatment of pancreatitis due to hypertriglyceridemia is similar to that of acute pancreatitis from other causes. It includes aggressive fluid resuscitation, pain control, and nutritional support. In acute pancreatitis, timely recognition of hypertriglyceridemia is crucial in the initial and long-term management of the disease. It is also critical for preventing the recurrence of acute pancreatitis.

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Elevated triglycerides on admission positively correlate with the severity of hypertriglyceridaemic pancreatitis

Cited by 9 publications

References 28 publications

Acute Pancreatitis: Diagnosis and Treatment

Acute Pancreatitis: Diagnosis and Treatment

The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis

Research on the clinical treatment of hypertriglyceridemia and acute pancreatitis

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