Hypertriglyceridemia triggered acute pancreatitis in pregnancy – diagnostic approach, management and follow-up care

Cruciat, Gheorghe; Nemeti, Georgiana; Goidescu, Iulian; Anitan, Stefan; Florian, Andreea Roxana

doi:10.1186/s12944-019-1180-7

Cited by 53 publications

(58 citation statements)

References 57 publications

(58 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 Biliary pancreatitis is the primary etiology cause of AP in general population, accounting for 40-70%, while HTG-AP is only 2-4%. 28 Different from the general population, the incidence of HTG-AP in pregnancy was much higher, 11,29 which reached 29.6-32.2% in several recent studies from East Asia. 13,16,30 In the present study, HTG-AP was the primary cause, accounting for 47%.…”

Section: Discussionmentioning

confidence: 91%

The Effect of Admission Serum Triglyceride Level on the Prediction of Severity of Acute Pancreatitis in Pregnancy

Sheng¹,

Wang²,

Xu³

et al. 2021

RMHP

View full text Add to dashboard Cite

Purpose: Previous studies indicated that the serum triglyceride level in patients with acute pancreatitis positively correlated with the severity of the disease among the general population. Despite the physiological hypertriglyceridemia in pregnant women, there are no reports on the relationship between serum triglyceride level and the severity of acute pancreatitis in pregnant (APIP) women. This study explores the relationship between serum triglyceride levels and the severity of APIP. Patients and Methods: Clinical information of APIP patients admitted to the Shengjing Affiliated Hospital of China Medical University was gathered from January 2012 to December 2020 to conduct retrospective research. The participating patients were divided into mild, moderately severe, and severe acute pancreatitis. The clinical outcomes of patients with different serum triglyceride levels (0-2.3 mmol/L, 2.23-5.65 mmol/L, 5.65-11.2 mmol/ l, ≥11.2 mmol/L) were analyzed by performing ordinal logistic regression analysis. Receiver operating curve analysis was used to calculate the threshold value of serum triglyceride concentration that can effectively predict the occurrence of severe acute pancreatitis (SAP). Results: Hypertriglyceridemic acute pancreatitis (HTG-AP) occurred in 47% of APIP patients within the group, with a high prevalence among the Han population. In the present study, the serum triglyceride concentration correlated positively with the severity of APIP (r=0.403, P < 0.05). The adjusted logistic model demonstrated that relative to nominal triglyceride levels, the OR value of SAP were 1.036 (95% CI: 0.401-2.677), ) with triglyceride at the level of 2.23-5.65 mmol/L, 5.65-11.2 mmol/l and ≥11.2 mmol/L. In APIP patients, a triglyceride concentration of 10.7mmol/L or more upon admission was a predictive value for the occurrence of SAP, with a sensitivity of 0.72 and a specificity of 0.65, AUC: 0.708 (95% CI: 0.620-0.796). Conclusion:As the serum triglyceride level upon admission increased, the frequency of local and systemic complications increased significantly.

show abstract

Section: Discussionmentioning

confidence: 91%

The Effect of Admission Serum Triglyceride Level on the Prediction of Severity of Acute Pancreatitis in Pregnancy

Sheng¹,

Wang²,

Xu³

et al. 2021

RMHP

View full text Add to dashboard Cite

show abstract

“…Hypertriglyceridemia may be the cause of important disease in pregnant patients. Patients with triglyceride levels exceeding 1,000 mg/dl are at increased risk of developing severe pancreatitis (Cruciat et al, 2020). Some studies reported that 54.1% (33/61) of the SAP patients had a high CrCl (more than 130 ml/min/1.73 m 2 ), and the serum trough concentration of vancomycin was significantly reduced in SAP patients with ARC (He et al, 2016;He et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

A Regression Model to Predict Augmented Renal Clearance in Critically Ill Obstetric Patients and Effects on Vancomycin Treatment

et al. 2021

View full text Add to dashboard Cite

Background: Augmented renal clearance (ARC) risk factors and effects on vancomycin (VCM) of obstetric patients were possibly different from other populations based on pathophysiological characteristics. Our study was to establish a regression model for prediction of ARC and analyze the effects of ARC on VCM treatment in critically ill obstetric patients.Methods: We retrospectively included 427 patients, grouped into ARC and non-ARC patients. Logistic regression analysis was used to analyze the factors related to ARC. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the model for ARC. Patients who received VCM therapy were collected. The published VCM population pharmacokinetic (PPK) model was used to calculate pharmacokinetic parameters. A linear regression analysis was made between the predicted and measured concentrations.Results: Of the 427 patients, ARC was present in 201 patients (47.1%). The independent risk factors of ARC were heavier, greater gestational age, higher albumin level, fewer caesarean section, severe preeclampsia and vasoactive drug; more infection, hypertriglyceridemia and acute pancreatitis. We established the above nine-variable prediction regression model and calculated the predicted probability. ROC curve showed that the predicted probability of combined weight, albumin and gestational age had better sensitivity (70.0%) and specificity (89.8%) as well as the maximal area under the curve (AUC, AUC = 0.863). 41 cases received VCM; 21 cases (51.2%) had ARC. The initial trough concentration in ARC patients was lower than in non-ARC patients (7.9 ± 3.2 mg/L vs 9.5 ± 3.3 mg/L; p = 0.033). Comparing the predicted trough concentration of two published VCM PPK models with the measured trough concentration, correlation coefficients (r) were all more than 0.8 in the ARC group and non-ARC group. AUC was significantly decreased in the ARC group (p = 0.003; p = 0.013), and clearance (CL) increased in the ARC group (p < 0.001; p = 0.008) when compared with the non-ARC group.Conclusion: ARC is a common state in critically ill obstetric patients. The regression model of nine variables had high predictive value for predicting ARC. The published VCM PPK models had good predictive performance for predicting trough concentrations of obstetric patients. Pharmacokinetic parameters of VCM are different in ARC obstetric patients, which results in enhanced VCM clearance and decreased trough concentration.

show abstract

“…Polygenic inheritance of multiple genes results in more common but milder levels of hypertriglyceridemia. Secondary factors such as insulin resistance, hypothyroidism, and glucocorticoids also play an important role ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Complication rates (peripancreatic collections, necrotizing pancreatitis) are twice as high in hypertriglyceridemia-induced pancreatitis ( 4 ). In pregnancy, hypertriglyceridemia-induced pancreatitis is associated with a higher risk of organ failure and intensive care support, and fetal loss, preterm labor, pre-eclampsia, and abruptio placentae ( 3 , 4 ). The accumulation of lipids also increases the risk of fetal macrosomia resulting in pre-term delivery ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia-induced pancreatitis in pregnancy: case review on the role of therapeutic plasma exchange

Tan

Teh

Kaushik

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

Summary Gestational hypertriglyceridemia-induced pancreatitis is associated with significant maternal and fetal morbidity and mortality. We report a case of gestational hypertriglyceridemia-induced pancreatitis in a primigravida at 31-weeks gestation, complicated by impending preterm labor and metabolic acidosis requiring hemodialysis. This was successfully managed with therapeutic plasma exchange (TPE), followed by i.v. insulin, low-fat diet, and omega-3. Triglyceride levels stabilized after TPE and the patient underwent an uncomplicated term delivery. In pregnancy, elevated estrogen and insulin resistance exacerbate hypertriglyceridemia. Management is challenging as risks and benefits of treatment options need to be weighed against fetal wellbeing. We discuss management options including a review of previous case reports detailing TPE use, dietary optimization, and delivery timing. This case emphasizes the importance of multidisciplinary care to optimize maternal and fetal outcomes. Learning points Gestational hypertriglyceridemia-induced pancreatitis has high morbidity. A multidisciplinary team approach is a key as maternal and fetal needs must be addressed. Rapid lowering of triglycerides is crucial and can be achieved successfully and safely with plasma exchange. A low-fat diet while ensuring adequate nutrition in pregnancy is important. Timing of delivery requires consideration of fetal maturity and risk of recurrent pancreatitis.

show abstract

Hypertriglyceridemia triggered acute pancreatitis in pregnancy – diagnostic approach, management and follow-up care

Cited by 53 publications

References 57 publications

The Effect of Admission Serum Triglyceride Level on the Prediction of Severity of Acute Pancreatitis in Pregnancy

The Effect of Admission Serum Triglyceride Level on the Prediction of Severity of Acute Pancreatitis in Pregnancy

A Regression Model to Predict Augmented Renal Clearance in Critically Ill Obstetric Patients and Effects on Vancomycin Treatment

Hypertriglyceridemia-induced pancreatitis in pregnancy: case review on the role of therapeutic plasma exchange

Contact Info

Product

Resources

About