Sa1400 - The Triad of Diabetes Ketoacidosis, Hypertriglyceridemia and Acute Pancreatitis. How Does it Affect Mortality and Morbidity? 10-Years Analysis of the National Inpatient Sample

Simons-Linares, C. Roberto; Lal, Pooja; Jang, Sunguk; Sanaka, Madhusudhan R.; Bhatt, Amit; Lopez, Rocio; Vargo, John J.; Stevens, Tyler; Chahal, Prabhleen

doi:10.1016/s0016-5085(18)31331-3

Cited by 10 publications

(28 citation statements)

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“…Patients with type 2 diabetes are twice as prone to AP individuals without diabetics 7 . The triad of AP coexisting with hypertriglyceridemia and diabetic ketoacidosis (DKA) has been rarely reported and constitutes a unique subgroup of patients showing high mortality and multiorgan failure 9 . The current regimen for the management of hypertriglyceridemia‐induced AP includes resting the pancreas, adequate fluid resuscitation, optimal pain control, insulin, and heparin treatment.…”

Section: Introductionmentioning

confidence: 99%

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Huang

et al. 2020

Journal of Diabetes

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Background This study aimed to analyze the genetics and treatments of the patients with the triad of diabetic ketoacidosis (DKA), hypertriglyceridemia, and acute pancreatitis (AP). Methods We conducted a retrospective study of six patients with the triad of AP, hypertriglyceridemia, and DKA at our hospital. All patients underwent plasmapheresis as part of their treatment. The clinical characteristics of the patients were obtained from the hospital information system and analyzed. Whole exome sequencing was performed using samples of one patient (case 6) and his family members. Results The average triglyceride level before plasmapheresis was 3282.17 ± 2975.43 mg/dL (range: 1646‐9332 mg/dL). The triglyceride levels dropped by approximately 80% after plasmapheresis. None of the patients developed complications related from plasmapheresis. During follow‐up, patients 5 and 6 developed recurrent pancreatitis for several times and showed the formation of pancreatic pseudocysts. We identified three novel heterozygous missense mutations in the family of patient 6, including c.12614C > T (p.Pro4205Leu) in APOB, c.160G > C (p.Glu54Gln) in CILP2, and c.1199C > A (p.Ala400Glu) in PEPD. Conclusions Three novel heterozygous missense mutations, including c.12614C > T (p.Pro4205Leu) in APOB, c.160G > C (p.Glu54Gln) in CILP2, and c.1199C > A (p.Ala400Glu) in PEPD were first identified in a patient with the triad of DKA, hypertriglyceridemia, and AP. The combination of plasmapheresis, hydration, and insulin therapy may have the greatest clinical benefits for these patients.

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Section: Introductionmentioning

confidence: 99%

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Huang

et al. 2020

Journal of Diabetes

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“…In agreement with our study finding, another large-scale population-based study investigating HTG-induced pancreatitis found lower mortality in patients with acute pancreatitis and HTG. These findings lend credibility to the possibility that the commonly accepted idea of HTG-induced pancreatitis being associated with increased disease severity when compared to other causes of pancreatitis is incorrect [ 26 ].…”

Section: Discussionmentioning

confidence: 57%

Higher Inpatient Morbidity and Mortality in Biliary Pancreatitis Compared to Hypertriglyceridemia-Induced Pancreatitis: A Nationwide Retrospective Study

Asotibe

Achebe

Pudasaini

2020

Cureus

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Introduction Hypertriglyceridemia (HTG)-induced pancreatitis is the third most common cause of acute pancreatitis after gallstone disease and alcohol. We analyzed data from the National (Nationwide) Inpatient Sample (NIS) with the aim of evaluating the outcomes of patients with HTG-induced pancreatitis when compared to those with biliary-induced pancreatitis. Methods The NIS database was sourced for data involving adult hospitalizations for HTG-induced pancreatitis in the United States between January 1, 2016 and December 31, 2017. The main outcome was mortality in patients with biliary pancreatitis vs HTG pancreatitis. Secondary outcomes were the incidence of sepsis, septic shock, non-ST-elevation myocardial infarction (NSTEMI), blood transfusion requirements, acute kidney failure, acute respiratory distress syndrome (ARDS), and length of hospital stay. Results A total of 575,230 patients were admitted with a diagnosis of acute pancreatitis, 18.2% of which were classified as having HTG pancreatitis. The in-hospital mortality for pancreatitis was 0.59%. Patients with HTG pancreatitis had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.74, 95% CI 0.582-0.934, p=0.012) compared to those with biliary pancreatitis. Patients with HTG pancreatitis had less odds of developing comorbid sepsis (aOR: 0.52, 95% CI 0.441-0.612, p<0.001), septic shock (aOR: 0.64, 95% CI 0.482-0.851, p<0.001), and NSTEMI (aOR: 0.70, 95% CI 0.535-0.926, p<0.001) and had less odds of requiring transfusion of blood products (aOR: 0.57, 95% CI 0.478-0.678, p<0.001) when compared to those with biliary pancreatitis. Patients with HTG pancreatitis also had a lower average length of hospital stay and lower total hospital charges compared to those with biliary pancreatitis. There was no statistical difference, however, in acute kidney failure and ARDS between the two groups.

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“…In this single-center retrospective cohort study of 2476 AP patients, we found that DKA presented in 52 cases (2.10%), which was similar to a previous study. 7 The coexistence of AP and DKA has been recognized since 1969 and reported infrequently during the past 40 years. 1,3,4,[13][14][15][16][17][18] Abdominal pain, a classical feature of AP, can be found in a number of patients with DKA, so the diagnosis of DKA is often delayed when AP is the initial diagnosis on presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with concurrent DKA had more severe organ dysfunction and acid-base disturbance, which were in accordance with the data from Quintanilla-Flores et al 20 Additionally, the existence of AP aggravated the severity of DKA due to marked acidosis, hyperglycemia, and increased depletion of intravascular volume. 6 Simons-Linares et al 7 recently performed the largest cohort study to date on the coexistence of AP and DKA, in which 2.8 million patients were hospitalized with AP and 33,356 had concomitant DKA. They found that patients with concomitant AP and DKA had higher complication rates of AKI, SIRS, shock, acute respiratory distress syndrome, sepsis, and ileus, which resulted in longer hospital stays and higher inpatient mortality rates compared with AP-only patients.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China

et al. 2020

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Objective: To evaluate the clinical characteristics of acute pancreatitis (AP) concomitant with diabetic ketoacidosis (DKA) in a cohort from South China and identify factors associated with early detection of DKA in AP patients. Methods: Inpatient medical records of AP concomitant with DKA were retrospectively reviewed. Results: Forty-eight patients with AP concomitant with DKA were enrolled in this study. The results indicated that comorbidity history of diabetes mellitus and mental status of not alert on admission were factors associated with DKA in AP patients. Compared with patients without DKA, patients with DKA showed significantly higher rates of hypertriglyceridemia and lower rates of gallstones than those without DKA. AP patients with concurrent DKA had higher levels of serum triglycerides, longer lengths of hospital stays, and higher complication rates of systemic inflammatory response syndrome and acute kidney injury. Conclusion: AP patients might have higher risks of concomitant DKA if presenting as not alert upon admission or if they have past medical histories of diabetes mellitus. Serum triglyceride levels were significantly higher in AP patients with DKA. DKA raised the severity of AP, but did not increase in-hospital mortality.

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Sa1400 - The Triad of Diabetes Ketoacidosis, Hypertriglyceridemia and Acute Pancreatitis. How Does it Affect Mortality and Morbidity? 10-Years Analysis of the National Inpatient Sample

Cited by 10 publications

References 0 publications

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

Higher Inpatient Morbidity and Mortality in Biliary Pancreatitis Compared to Hypertriglyceridemia-Induced Pancreatitis: A Nationwide Retrospective Study

Acute pancreatitis concomitant with diabetic ketoacidosis: a cohort from South China

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