The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?

Simons-Linares, C. Roberto; Jang, Sunguk; Sanaka, Madhusudan; Bhatt, Amit; López, Rocío; Vargo, John J.; Stevens, Tyler; Chahal, Prabhleen

doi:10.1097/md.0000000000014378

Cited by 25 publications

(20 citation statements)

References 5 publications

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“…26 A study of 2.8 million patients with acute pancreatitis indicated that compared with simple HTG-AP patients, DKA and HTG triad had significantly higher mortality, multiple organ failure rate, longer hospitalization periods, and higher costs in AP patients. 36 In the present study, there were 20 cases of DKA (10%). The incidence of DKA in the TG≥11.2 mmol/L group was 18.75%, which was higher than those of the other three groups.…”

Section: Discussionsupporting

confidence: 44%

“…AP, DKA, and HTG are often mutually causal and interact with each other to form a "death triangle". 36 The state of high blood sugar, high blood ketones, dehydration, electrolyte disturbances, and metabolic acidosis make patients prone to hyperosmolar coma and eventually life-threatening circumstances. 26 A study of 2.8 million patients with acute pancreatitis indicated that compared with simple HTG-AP patients, DKA and HTG triad had significantly higher mortality, multiple organ failure rate, longer hospitalization periods, and higher costs in AP patients.…”

Section: Discussionmentioning

confidence: 99%

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

Sheng¹,

Wang²,

Xu³

et al. 2021

RMHP

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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.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

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

“…On admission, our patient presented many risk factors such as obesity, familiar hypertriglyceridemia, sedentary lifestyle, and excessive sugar-sweetened soft drinks daily intake. Classical triad of DKA-HTG-AP was confirmed, a rare evidence described with 11% prevalence in overall AP patients, unfortunately associated with higher rate of inpatient mortality, multiorgan failure, parental nutrition requirement, hospital charges, and longer hospital length of stay [17]. Moreover, the association of negative autoimmune markers and good β-cell function assigned a 54% probability of developing ketones in our patient [3].…”

Section: Discussionsupporting

confidence: 71%

A Triad of Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis Associated With Sugar-Sweetened Soft Drinks Abuse in a Caucasian Patient With Undiagnosed Type 2 Diabetes Mellitus

Vitelli

Apuzzi

Calderaro

et al. 2020

Cureus

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A 24-year-old obese Caucasian male, without relevant anamnesis, who was admitted to the ER presented with abdominal pain, nausea and vomiting, hyperglycemia, and diabetic ketoacidosis (DKA). The diagnosis of acute pancreatitis (AP) was supported by increased serum levels of triglycerides and lipase associated with abdominal CT scans. The patient was treated for five days with IV regular insulin, hydration, electrolytes replacement, and statin/fibrate therapy with clinical improvement. Some 10% hemoglobin A1c value, normal C-peptide level and negative glutamic acid decarboxylase (GAD-65), and islet cell autoantibodies suggested the diagnosis of a new-onset type 2 diabetes mellitus (DM) presenting with an uncommon triad of DKA and hypertriglyceridemia (HTG)-induced AP. Anamnestic history suggested that DKA was dependent on sugar-sweetened soft drinks abuse (soft drink ketosis), a clinical association more frequent in Asian than in Western patients.

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“…In agreement with our study finding, another largescale 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: Discussionsupporting

confidence: 54%

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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The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?

Cited by 25 publications

References 5 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 Triad of Ketoacidosis, Hypertriglyceridemia, and Acute Pancreatitis Associated With Sugar-Sweetened Soft Drinks Abuse in a Caucasian Patient With Undiagnosed Type 2 Diabetes Mellitus

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

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