The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis

Abstract

Background Hypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers. Methods Laboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP. Results Seventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (all P < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L, P = 0.004, OR = 3.362, 95%CI = 1.492–8.823) and apolipoprotein A-I (< 1.1 g/L, P < 0.001, OR = 5.126, 95%CI = 2.348–11.195), as well as high C-reactive protein (> 90 mg/L, P = 0.005, OR = 3.061, 95%CI = 1.407–6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070–4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (all P < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (all P < 0.05). Conclusions Low serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.

The challenge of prognostic markers in acute pancreatitis: internist’s point of view

“…In our case study, the mortality rate resulted 2.77%, similar to data reported in literature (the mortality rate changes from 2.5% for mild AP to 30% for moderate-severe form 30%) [ 1 , 10 , 11 ].…”

Automated Machine Learning for the Early Prediction of the Severity of Acute Pancreatitis in Hospitals

“…A large-scale retrospective study analyzed the two open-access ICU databases to reveal the predictive significance of serum albumin in patients with AP (Xu et al, 2020). Chen and colleagues (Chen et al, 2021) carried out a subanalysis in hypertriglyceridemia pancreatitis populations for exploring the association between albumin and severity of AP. It was generally believed that elevated level of TG would drive the occurrence of SAP due to toxic effects on pancreatic acinar cell (Chen et al, 2021).…”

“…Chen and colleagues (Chen et al, 2021) carried out a subanalysis in hypertriglyceridemia pancreatitis populations for exploring the association between albumin and severity of AP. It was generally believed that elevated level of TG would drive the occurrence of SAP due to toxic effects on pancreatic acinar cell (Chen et al, 2021). The free fatty acids, hydrolyzed by pancreatic lipase from TGs, can bind to albumin in the serum and thus stimulate the inflammatory process.…”

Impacts of body composition parameters and liver cirrhosis on the severity of alcoholic acute pancreatitis

“…Several recent studies have shown that computed tomography (CT) defined muscle and adipose tissue features are associated with AP severity and mortality [17][18][19][20][21][22][23][24]. Since most patients undergo CT during the diagnosis of AP, predictions of prognosis of AP by simple body composition analyses using CT images is a cost-effective proposition.…”

“…Since most patients undergo CT during the diagnosis of AP, predictions of prognosis of AP by simple body composition analyses using CT images is a cost-effective proposition. Subcutaneous adipose tissue (SAT) are [18][19][20][21][22], visceral adipose tissue (VAT) area [17][18][19][20][21][22][23][24], skeletal muscle mass or density [17][18][19][20][21]24], visceral fat-to-muscle ratio (VMR) [21,22], and mean muscle attenuation (MMA) [19,21] have all been evaluated in the context of CT-defined body composition analysis. In addition, fatty liver has also been reported to affect AP severity [25].…”