Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity

Zhang, Ruwen; Deng, Lihui; Jin, Tao; Zhu, Ping; Shi, Na; Jiang, Kun; Li, Lan; Yang, Xunzhe; Guo, Jia; Yang, Xiaonan; Liu, Tingting; Mukherjee, Rajarshi; Singh, Vikesh K.; Windsor, John A.; Sutton, Robert; Huang, Wei; Xia, Qing

doi:10.1016/j.hpb.2019.01.015

Cited by 69 publications

(75 citation statements)

References 38 publications

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“…The median age was 45 years (range 19 to 70 years), and 68% were males. Hypertriglyceridemia (36.7%) was the leading etiology, followed by biliary (23.1%) and alcohol (7.8%), consistent with our recent findings from large cohorts [ 2 , 35 , 36 ]. The median time from symptom onset to general ward admission was 24 h (range 6–48 h), and that from ED to general ward was 6.5 h (range 4–19.5 h).…”

Section: Resultssupporting

confidence: 91%

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Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Jin

Wen

et al. 2020

Dig Dis Sci

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Background/Aims Hematocrit is a widely used biomarker to guide early fluid therapy for patients with acute pancreatitis (AP), but there is controversy over whether early rapid fluid therapy (ERFT) should be used in hemoconcentrated patients. This study investigated the association of hematocrit and ERFT with clinical outcomes of patients with AP. Methods Data from prospectively maintained AP database and retrospectively collected fluid management details were stratified according to actual severity defined by revised Atlanta classification. Hemoconcentration and "early" were defined as hematocrit > 44% and the first 6 h of general ward admission, respectively, and "rapid" fluid rate was defined as ≥ 3 ml/ kg/h. Patients were allocated into 4 groups for comparisons: group A, hematocrit ≤ 44% and fluid rate < 3 ml/kg/h; group B, hematocrit ≤ 44% and fluid rate ≥ 3 ml/kg/h; group C, hematocrit > 44% and fluid rate < 3 ml/kg/h; and group D, hematocrit > 44% and fluid rate ≥ 3 ml/kg/h. Primary outcome was rate of noninvasive positive-pressure ventilation (NPPV). Results A total of 912 consecutive AP patients were analyzed. ERFT has no impact on clinical outcomes of hemoconcentrated, non-severe or all non-hemoconcentrated AP patients. In hemoconcentrated patients with severe AP (SAP), ERFT was accompanied with increased risk of NPPV (odds ratio 5.96, 95% CI 1.57-22.6). Multivariate regression analyses confirmed ERFT and hemoconcentration were significantly and independently associated with persistent organ failure and mortality in patients with SAP. Conclusions ERFT is associated with increased rate of NPPV in hemoconcentrated patients with SAP.

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Section: Resultssupporting

confidence: 91%

supporting

confidence: 91%

Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Jin

Wen

et al. 2020

Dig Dis Sci

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“…While the presence of severe hypertriglyceridaemia (>11.3 mmol/L, >1000 mg/dL) was considered diagnostic for hypertriglyceridaemia as the primary aetiology [21], triglyceride concentrations in our patients were generally low; only a third of patients had hypertriglyceridaemia. Another study that evaluated hypertriglyceridaemia in acute pancreatitis similarly found elevated triglycerides in a third of the included 1233 patients in agreement with our findings, which consisted of 10% with moderate hypertriglyceridaemia and 22% with severe hypertriglyceridaemia [14]. As there is no clear threshold at which hypertriglyceridaemia is known to trigger acute pancreatitis [10], hypertriglyceridaemia remains a probable primary aetiology of acute pancreatitis if serum triglyceride concentrations are raised and other aetiologies of acute pancreatitis are excluded [21].…”

Section: Strengths and Limitationssupporting

confidence: 87%

“…However, if a patient had severe hypertriglyceridaemia, this was the primary cause of acute pancreatitis regardless of the presence of other potential aetiologies. There is currently a lack of minimum diagnostic triglyceride concentration for hypertriglyceridaemia associated acute pancreatitis [14]. Iatrogenic acute pancreatitis was diagnosed if acute pancreatitis was caused by a procedure such as endoscopic retrograde cholangiopancreatography (ERCP).…”

Section: Definition Of Primary Aetiologymentioning

confidence: 99%

Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study

Adiamah

Kushairi

Tumilty

et al. 2020

Clinical Nutrition ESPEN

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Background and aims: Hypertriglyceridaemia is both a primary cause of acute pancreatitis and an epiphenomenon. This study aimed to define the associations between hypertriglyceridaemia and clinical outcomes in patients admitted with acute pancreatitis. Methods: This single-centre prospective observational study included patients with a confirmed clinical, biochemical or radiological diagnosis of acute pancreatitis from August 2017 to September 2018. Baseline demographics, aetiology of pancreatitis, and fasting triglyceride concentrations were recorded and assessed against the surrogate markers of severity: admission to critical care, length of stay (LOS), readmission to hospital, and mortality. Results: In total, 304 patients with a mean ± SD age of 56.1 ± 19.7 years met the inclusion criteria. There were 217 (71.4%) patients with normotriglyceridaemia (<150 mg/dL or <1.7 mmol/L), 47 (15.5%) with mild hypertriglyceridaemia (150e199 mg/dL or 1.7e2.25 mmol/L) and 40 (13.2%) with moderate-tosevere hypertriglyceridaemia (!200 mg/dL or >2.25 mmol/L). The underlying aetiologies of acute pancreatitis were gallstones (55%), alcohol (18%), idiopathic (15%), hypertriglyceridaemia (9%), iatrogenic (2%) and bile duct abnormalities (1%). Patients with hypertriglyceridaemia were younger than those with normotriglyceridaemia (p < 0.05). On multivariate regression, moderate-to-severe hypertriglyceridaemia (OR 5.66, 95% CI: 1.87 to 17.19, p ¼ 0.002) and an elevated C-reactive protein concentration !120 mg/L (OR 1.00, 95% CI: 1.00e1.01, p ¼ 0.040) were associated with admission to critical care. Moderate-tosevere hypertriglyceridaemia was also associated with an increased LOS (p ¼ 0.002) but not readmission (p ¼ 0.752) or mortality (p ¼ 0.069). Conclusion: Moderate-to-severe hypertriglyceridaemia in all aetiological causes of acute pancreatitis was predictive of admission to critical care and prolonged LOS but not readmission or mortality.

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“…Acute pancreatitis secondary to hypertriglyceridemia is uncommon in Western populations and is more often associated with severe disease, organ failure, and death than other etiologies. 8 No patient presented here had transient or persistent organ failure, and the main reason for the prolonged length of stay in all cases was poor diabetic control or persistent elevation of serum inflammatory markers. We speculate that because of the low levels of free pancreatic enzymes (as evidenced by near-normal levels of circulating pancreatic amylase), toxic lipolysis does not occur, and the liver is able to absorb most triglycerides resulting in the changes in hepatic steatosis observed.…”

Section: Discussionmentioning

confidence: 76%

Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2–associated Pancreatitis

et al. 2020

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A s the global pandemic of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) continues, nuances of the disease it precipitates in humans continue to emerge. After early reports of presentation with gastrointestinal-type symptoms in China 1 and Italy, 2 a group from Wuhan reported a series of 9 patients with purported pancreatic injury in the context of SARS-CoV2 infection 3 but did not provide robust evidence for pancreatitis. relying on mild hyperamylasemia alone. Current international consensus for a diagnosis of acute pancreatitis requires 2 of the following 3 features: abdominal pain consistent with pancreatitis, serum amylase/lipase greater than 3 times the upper limit of normal, and characteristic findings on cross-sectional imaging. 4 Simply put, there are too many causes for hyperamylasemia in the context of systemic illness, with or without SARS-CoV2, for its use in isolation as a marker of pancreatic injury. Nonetheless, we report here 5 cases of atypical but proven acute pancreatitis in the context of SARS-CoV2 infection. Methods This review was registered with the Liverpool University Hospitals NHS Foundation Trust audit department (ID TA0002744). Cases were identified by searching admission diagnoses (International Classification of Diseases, 10th revision code K85) or radiology requests and reports for "acute pancreatitis." SARS-CoV2 was diagnosed when either swabs were positive on rapid polymerase chain reaction (VIASURE, Certest Biotec, Spain) or patients had radiologic evidence of SARS-CoV2 infection (Supplementary Figure 1). Cases with pre-existing pancreatic pathology or where the etiology was clearly non-SARS-CoV2 related were excluded. Data extracted from patient and radiology records were used to calculate clinical scores and hepatic steatosis estimates by analysis of contrast-enhanced computed tomography (CECT) images as previously described. 5 Imaging findings were rereported by an expert pancreatic radiologist.

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Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity

Cited by 69 publications

References 38 publications

Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Early Rapid Fluid Therapy Is Associated with Increased Rate of Noninvasive Positive-Pressure Ventilation in Hemoconcentrated Patients with Severe Acute Pancreatitis

Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study

Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2–associated Pancreatitis

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